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Conrad EJ, Rajo EM, Barker C, Beiter K, Hughes JB, Stuart S. The Trauma Recovery Clinic: A Stepped Collaborative Care Model for Trauma Surgery Patients to Address Health Disparities. Am Surg 2024:31348241262431. [PMID: 38889953 DOI: 10.1177/00031348241262431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Background: The Trauma Recovery Clinic (TRC) was developed to meet the psychiatric, psychological, and psychosocial needs of traumatically injured patients following discharge from a level-I trauma center. The objective of this study is to demonstrate the efficacy of the TRC as an application of the stepped collaborative care model in order to address health disparities.Methods: Patients with a history of inpatient treatment for a physically traumatic injury at this level-I trauma center were approached and enrolled at initial TRC outpatient appointments. Data was collected, including the PTSD Checklist-Civilian Version (PCL-C), the Patient Health Questionnaire (PHQ-9), the Attitudes towards Guns scale, and the Youth Behavior Risk Survey (questions about weapon carrying practices).Results: A total of 80 patients were included in this study. Patients expressed several social determinants of health risk factors, with 60% of the sample reporting witnessing someone being wounded or killed. Results demonstrated a significant decrease in trauma symptoms (T24 = 3.33; P = .001, d = 0.67) and depressive symptoms (T24 = 2.23, P = .02, d = 0.45) by their 6th clinic visit. Additionally, patients reported significant improvements in role limitations due to emotional problems (T25 = 1.74; P = .04; d = 0.34) and social functioning (T25 = 2.23; P = .02; d = 0.43). Interestingly, patients who reported carrying a weapon in the last 30 days reported significantly higher trauma symptoms (T64 = 3.21, P = .002) and depressive symptoms (T64 = 2.77, P = .007).Discussion: This evaluation of services at the recently implemented Trauma Recovery Clinic demonstrated that the clinic is successfully treating individuals who have experienced traumatic injuries. More specifically, the clinic services are effectively engaging a vulnerable, hard-to-reach patient population.
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Affiliation(s)
- Erich J Conrad
- Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Erika M Rajo
- Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Chikira Barker
- Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Kaylin Beiter
- Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Jennifer B Hughes
- Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Sarah Stuart
- Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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Adugna D, Yadeta TA, Dereje J, Firdisa D, Demissie Darcho S, Kassa O, Kitessa M, Gemeda AT. Post-traumatic stress disorder and associated factors among inpatients at Eastern Command Referral Hospital in Dire Dawa, Eastern Ethiopia. Front Psychiatry 2024; 15:1373602. [PMID: 38919638 PMCID: PMC11197465 DOI: 10.3389/fpsyt.2024.1373602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 05/21/2024] [Indexed: 06/27/2024] Open
Abstract
Background Post-traumatic stress disorder (PTSD) is characterized by heightened stress and anxiety after experiencing a traumatic event. While numerous studies have been conducted to investigate the magnitude and factors associated with PTSD, there is limited evidence available on specific study populations of military personnel. Objective The study aimed to determine the magnitude of post-traumatic stress disorder and associated factors among military personnel admitted to the Eastern Command Referral Hospital in Eastern Ethiopia from May 1 to 30, 2023. Methods and materials A cross-sectional study was carried out at an institution. Face-to-face interviews were conducted to collect data using the post-traumatic stress disorder military version checklist for the Diagnostic and Statistical Manual, Fifth Edition. Data were entered and analyzed using EpiData version 3.1 and STATA version 14. Descriptive statistics were employed to summarize the information. To investigate factors linked with outcome variables, bivariate and multivariate logistic regression analyses were conducted. The results were presented using odds ratios with 95% confidence intervals, with statistical significance given at a p-value of 0.05. Results This study found that approximately 23.6% (95% CI = 19.9-27.8) of admitted military members fulfilled the diagnostic criteria for PTSD. Participants' history of mental illness [adjusted odds ratio (AOR) = 5.73, 95% CI = 2.66-12.31], family history of mental illness (AOR = 10.38, 95% CI = 5.36-20.10), current chewing of khat (AOR = 2.21, 95% CI = 1.13-4.32), physical trauma (AOR = 2.03, 95% CI = 1.00-4.13), moderate social support (AOR = 0.27, 95% CI = 0.1-4.53), strong social support (AOR = 0.09, 95% CI = 0.02-0.35), and severe depression (AOR = 2.06, 95% CI = 1.74-5.71) were factors significantly associated with post-traumatic stress disorder. Conclusions The magnitude of post-traumatic stress disorder is high among military personnel. Factors such as participants' history of mental illness, family history of mental illness, depression, lack of social support, current use of khat, and physical trauma are significantly associated with PTSD. It is crucial to identify and intervene early in individuals with these risk factors to address PTSD effectively.
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Affiliation(s)
- Desalegn Adugna
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Tesfaye Assebe Yadeta
- Department of Nursing, School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Jerman Dereje
- Department of Psychiatry, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Dawit Firdisa
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Samuel Demissie Darcho
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Obsan Kassa
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Monas Kitessa
- School of Pharmacy, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Asefa Tola Gemeda
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
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The relationship between multiple traumatic events and the severity of posttraumatic stress disorder symptoms – evidence for a cognitive link. Eur J Psychotraumatol 2023; 14:2165025. [PMID: 37052097 PMCID: PMC9879173 DOI: 10.1080/20008066.2023.2165025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background: Previous research has shown that multiple traumatic experiences cumulatively increase the risk for the development of severe symptoms of posttraumatic stress disorder (PTSD). Yet, little is known about the specific psychological mechanism through which this increased risk comes about.Objective: In the present study, we examined a possible cognitive link between multiple traumatic events and PTSD symptom severity through dysfunctional cognitions and expectations.Methods: A sample of patients with a diagnosed PTSD (N = 70; MAge = 42.06; 82% female) and high symptom burden (IES-R M = 79.24) was examined. On average, patients had experienced 5.31 different traumatic events. In a structural equation model, we tested the hypothesis that the relationship between multiple traumatic experiences and PTSD symptom severity is mediated through dysfunctional general cognitions and dysfunctional situation-specific expectations. General trauma-related cognitions were assessed with the Posttraumatic Cognition Inventory (PTCI) and trauma-related situational expectations were assessed with the Posttraumatic Expectations Scale (PTES).Results: The direct effect of the number of traumatic events on PTSD symptom severity was non-significant. Instead, as hypothesised, there was evidence for a significant indirect effect via dysfunctional general cognitions and situation-specific expectations.Conclusions: The current results further specify the cognitive model of PTSD by indicating that the relationship between the number of traumatic events and PTSD symptom severity is mediated through dysfunctional cognitions and expectations. These findings emphasise the importance of focused cognitive treatment approaches that seek to modify dysfunctional cognitions and expectations in people with multiple traumatic experiences.
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Fuller BM, Driver BE, Roberts MB, Schorr CA, Thompson K, Faine B, Yeary J, Mohr NM, Pappal RD, Stephens RJ, Yan Y, Johnson NJ, Roberts BW. Awareness with paralysis and symptoms of post-traumatic stress disorder among mechanically ventilated emergency department survivors (ED-AWARENESS-2 Trial): study protocol for a pragmatic, multicenter, stepped wedge cluster randomized trial. Trials 2023; 24:753. [PMID: 38001507 PMCID: PMC10675941 DOI: 10.1186/s13063-023-07764-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Awareness with paralysis (AWP) is memory recall during neuromuscular blockade (NMB) and can cause significant psychological harm. Decades of effort and rigorous trials have been conducted to prevent AWP in the operating room, where prevalence is 0.1-0.2%. By contrast, AWP in mechanically ventilated emergency department (ED) patients is common, with estimated prevalence of 3.3-7.4% among survivors given NMB. Longer-acting NMB use is a critical risk for AWP, and we have shown an association between ED rocuronium use and increased AWP prevalence. As NMB are given to more than 90% of ED patients during tracheal intubation, this trial provides a platform to test an intervention aimed at reducing AWP. The overall objective is to test the hypothesis that limiting ED rocuronium exposure will significantly reduce the proportion of patients experiencing AWP. METHODS This is a pragmatic, stepped wedge cluster randomized trial conducted in five academic EDs, and will enroll 3090 patients. Per the design, all sites begin in a control phase, under observational conditions. At 6-month intervals, sites sequentially enter a 2-month transition phase, during which we will implement the multifaceted intervention, which will rely on use of nudges and defaults to change clinician decisions regarding ED NMB use. During the intervention phase, succinylcholine will be the default NMB over rocuronium. The primary outcome is AWP, assessed with the modified Brice questionnaire, adjudicated by three independent, blinded experts. The secondary outcome is the proportion of patients developing clinically significant symptoms of post-traumatic stress disorder at 30 and 180 days after hospital discharge. We will also assess for symptoms of depression and anxiety, and health-related quality of life. A generalized linear model, adjusted for time and cluster interactions, will be used to compare AWP in control versus intervention phases, analyzed by intention-to-treat. DISCUSSION The ED-AWARENESS-2 Trial will be the first ED-based trial aimed at preventing AWP, a critical threat to patient safety. Results could shape clinical use of NMB in the ED and prevent more than 10,000 annual cases of AWP related to ED care. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT05534243 . Registered 06, September 2022.
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Affiliation(s)
- Brian M Fuller
- Department of Anesthesiology, Division of Critical Care, Department of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA.
| | - Brian E Driver
- Department of Emergency Medicine, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN, 55415, USA
| | - Michael B Roberts
- Department of Institutional Research, Department of Psychology, Philadelphia College of Osteopathic Medicine, Rowland Hall, 514B, 4190 City Avenue, Philadelphia, PA, 19131, USA
| | - Christa A Schorr
- Cooper Research Institute, Cooper University Health Care, One Cooper Plaza, Dorrance, Camden, NJ, 08103, USA
| | - Kathryn Thompson
- Department of Emergency Medicine, University of Washington/Harborview Medical Center, 325 9th Avenue, Seattle, WA, 98104, USA
| | - Brett Faine
- Departments of Emergency Medicine and Pharmacy, Roy J. and Lucille A. Carver College of Medicine, University of Iowa College of Pharmacy, 200 Hawkins Drive, 1008 RCP, Iowa City, IA, 52242, USA
| | - Julianne Yeary
- Emergency Department, Charles F. Knight Emergency and Trauma Center, Barnes-Jewish Hospital, 1 Barnes Jewish Hospital Plaza, St. Louis, MO, 63110, USA
| | - Nicholas M Mohr
- Departments of Emergency Medicine and Anesthesiology, Division of Critical Care, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, 200 Hawkins Drive, 1008 RCP, Iowa City, IA, 52242, USA
| | - Ryan D Pappal
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Robert J Stephens
- Department of Medicine, Division of Critical Care Medicine, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD, 21201, USA
| | - Yan Yan
- Division of Public Health Sciences, Department of Surgery, Division of Biostatistics, Washington University School of Medicine, 418E, 2Nd Floor, 600 South Taylor Ave., St. Louis, MO, 63110, USA
| | - Nicholas J Johnson
- Departments of Emergency Medicine and Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington/Harborview Medical Center, 325 9th Avenue, Seattle, WA, 98104, USA
| | - Brian W Roberts
- Department of Emergency Medicine, Cooper Medical School of Rowan University, One Cooper Plaza, K152, Camden, NJ, 08103, USA
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Sheehy KA, Hruska B, Waldrep EE, Pacella-LaBarbara ML, George RL, Benight CC, Delahanty DL. The mediating role of coping self-efficacy on social support and PTSD symptom severity among injury survivors. ANXIETY, STRESS, AND COPING 2023; 36:770-780. [PMID: 37128653 DOI: 10.1080/10615806.2023.2199208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 01/21/2023] [Accepted: 03/27/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Social support confers a protective effect against elevated PTSD symptomatology following injury. However, little is known about the mechanisms through which social support conveys this protective mental health effect in injury survivors. Coping self-efficacy is linked to both social support and PTSD symptomatology but has not been examined. OBJECTIVE To test coping self-efficacy as a mechanism for the relationship between social support and PTSD symptom severity among injury survivors. METHOD AND DESIGN Participants consisted of 61 injury survivors (62.3% male, 72.1% White) admitted to a Level-1 Trauma Center. Social support was assessed at 2-weeks post-injury; coping self-efficacy at 6-weeks post-injury; and PTSD symptom severity at 3-months post-injury. RESULTS A statistically significant indirect effect was found for the social support - coping self-efficacy - PTSD symptomatology pathway, providing evidence of mediation even after controlling for age, sex, race, and education (B = -0.51, SE = 0.18, CI = -0.92, -0.20). CONCLUSIONS Social support may exert an effect on PTSD symptom severity post-injury through its connection with coping self-efficacy. Coping self-efficacy represents an important intervention target following injury for those survivors with lower social support who are at risk for elevated PTSD symptom severity levels.
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Affiliation(s)
- Kriszha A Sheehy
- Department of Psychology, Pacific Lutheran University, Tacoma, USA
| | - Bryce Hruska
- Department of Public Health, Syracuse University, Syracuse, USA
| | | | | | | | - Charles C Benight
- Trauma, Health, and Hazards Center and Psychology Department, University of Colorado at Colorado Springs, Colorado Springs, USA
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Brier ZMF, Hidalgo JE, Espeleta HC, Davidson T, Ruggiero KJ, Price M. Assessment of Traumatic Stress Symptoms During the Acute Posttrauma Period. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:239-246. [PMID: 37404969 PMCID: PMC10316216 DOI: 10.1176/appi.focus.20230001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
A substantial majority of adults in the United States will experience a potentially traumatic event (PTE) in their lifetime. A considerable proportion of those individuals will go on to develop posttraumatic stress disorder (PTSD). Distinguishing between those who will develop PTSD and those who will recover, however, remains as a challenge to the field. Recent work has pointed to the increased potential of identifying individuals at greatest risk for PTSD through repeated assessment during the acute posttrauma period, the 30-day period after the PTE. Obtaining the necessary data during this period, however, has proven to be a challenge. Technological innovations such as personal mobile devices and wearable passive sensors have given the field new tools to capture nuanced in vivo changes indicative of recovery or nonrecovery. Despite their potential, there are numerous points for clinicians and research teams to consider when implementing these technologies into acute posttrauma care. The limitations of this work and considerations for future research in the use of technology during the acute posttrauma period are discussed.
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Affiliation(s)
- Zoe M F Brier
- Department of Psychological Science, University of Vermont, Burlington (Brier, Hidalgo, Price); Department of Psychiatry and Behavioral Sciences (Brier) and College of Nursing (Espeleta, Davidson, Ruggiero), Medical University of South Carolina, Charleston
| | - Johanna E Hidalgo
- Department of Psychological Science, University of Vermont, Burlington (Brier, Hidalgo, Price); Department of Psychiatry and Behavioral Sciences (Brier) and College of Nursing (Espeleta, Davidson, Ruggiero), Medical University of South Carolina, Charleston
| | - Hannah C Espeleta
- Department of Psychological Science, University of Vermont, Burlington (Brier, Hidalgo, Price); Department of Psychiatry and Behavioral Sciences (Brier) and College of Nursing (Espeleta, Davidson, Ruggiero), Medical University of South Carolina, Charleston
| | - Tatiana Davidson
- Department of Psychological Science, University of Vermont, Burlington (Brier, Hidalgo, Price); Department of Psychiatry and Behavioral Sciences (Brier) and College of Nursing (Espeleta, Davidson, Ruggiero), Medical University of South Carolina, Charleston
| | - Kenneth J Ruggiero
- Department of Psychological Science, University of Vermont, Burlington (Brier, Hidalgo, Price); Department of Psychiatry and Behavioral Sciences (Brier) and College of Nursing (Espeleta, Davidson, Ruggiero), Medical University of South Carolina, Charleston
| | - Matthew Price
- Department of Psychological Science, University of Vermont, Burlington (Brier, Hidalgo, Price); Department of Psychiatry and Behavioral Sciences (Brier) and College of Nursing (Espeleta, Davidson, Ruggiero), Medical University of South Carolina, Charleston
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Buxton H, Marr MC, Hernandez A, Vijanderan J, Brasel K, Cook M, Moreland-Capuia A. Peer-to-Peer Trauma-Informed Training for Surgical Residents Facilitated by Psychiatry Residents. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023; 47:59-62. [PMID: 35579850 PMCID: PMC9669278 DOI: 10.1007/s40596-022-01648-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/05/2022] [Indexed: 05/13/2023]
Abstract
OBJECTIVE This article describes the implementation of trauma-informed care (TIC) didactic training, using a novel, interdisciplinary peer-to-peer teaching model to improve confidence surrounding trauma-informed practices in a surgical residency program. METHODS Eight psychiatry residents and two medical students with a background in psychological trauma and TIC and an interest in medical education were recruited to participate in three 2-hour "train the trainer" sessions led by a national expert in TIC. Eight psychiatry residents and two medical students subsequently developed and delivered the initial TIC training to 29 surgical interns. Training included the neurobiology of psychological trauma, principles of trauma-informed care, and developing trauma-informed curricula. RESULTS Surgical interns reported significantly improved understanding of the physiology of trauma, knowledge of TIC approaches, and confidence and comfort with TIC and practices. Among surgical interns, understanding of the physiology of the fear response increased from 3.36 to 3.85 (p = 0.03). Knowledge of the neurobiology of trauma improved between pre- and post-training surveys (2.71 to 3.64, p = 0.006). Surgery interns also expressed an improved understanding of the connection between fear, trauma, and aggression (3.08 to 4.23, p = 0.002) from pre- to post-training surveys. Post-training knowledge of trauma-informed approaches increased from 2.57 to 4.71 (p < 0.001) and confidence in delivering TIC on the wards increased from 2.79 to 4.64 (p < 0.001). CONCLUSION This TIC curriculum delivered via a peer-to-peer training model presents an effective way to improve comfort and confidence surrounding TIC practices and approaches in a surgical residency training program.
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Affiliation(s)
| | - Mollie C Marr
- Oregon Health & Science University, Portland, OR, USA
| | | | | | - Karen Brasel
- Oregon Health & Science University, Portland, OR, USA
| | | | - Alisha Moreland-Capuia
- Oregon Health & Science University, Portland, OR, USA.
- McLean Hospital/Harvard Medical School, Belmont, MA, USA.
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Furdock RJ, Feldman B, Sinkler M, Connelly M, Hoffa M, Simpson M, Hendrickson SB, Vallier HA. Factors influencing participation in psychosocial programming among orthopaedic trauma patients with PTSD. Injury 2022; 53:4000-4004. [PMID: 36184361 DOI: 10.1016/j.injury.2022.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/22/2022] [Accepted: 09/25/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Post Traumatic Stress Disorder (PTSD) commonly occurs following acute trauma. Post-injury outcomes are negatively impacted by PTSD. Trauma Recovery Services (TRS) programming was developed at our institution in 2013 to provide psychosocial programming that increases patient satisfaction with care and ability to return to work and decreases PTSD symptoms. We sought to identify factors that influence patients' decision to participate in programming. METHODS Over a 3-year period at a single, urban level 1 trauma center, 172 patients over the age of 18 screened positive for PTSD on the validated PTSD checklist for DSM-5 (PCL-5) screening tool. Demographic, socioeconomic, injury, and medical comorbidity information was collected. Variables were initially compared in a univariate manner via Chi-squared, Fisher exact, t-test, or Mann-Whitney U, as appropriate. Variables that had a p-value <0.2 on univariate analysis were entered into a backward stepwise logistic regression model to identify independent predictors of participation in TRS programming. RESULTS Mean age was 37.8 years. 70.1% of patients were male. The most common mechanisms of injury were gunshot wound (33.7%), motor vehicle crash (19.0%), and burn. 33.5% of patients participated in TRS programming. Nine predictors had p<.2 on univariate analysis and were entered into the stepwise regression model. Four predictors remained in the final model. Patients with private insurance (RR=2.2, p=.038), high school diploma or greater (RR=1.53, p=.002; Table 1), and PCL-5 score greater than 50 were more likely to participate in TRS programming (RR=1.42, p=.046). Patients who live 20 or more minutes away by car from TRS were less likely to participate in programming (RR=0.47, p=.065). DISCUSSION Patients with more severe PTSD, higher levels of education, and private insurance were more likely to participate in TRS programming. Participation in TRS and similar psychosocial programs may be improved by minimizing the participant's potential commute to the program location.
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Affiliation(s)
- Ryan J Furdock
- Study performed at MetroHealth Medical Center, an affiliate of Case Western Reserve University School of Medicine, USA
| | - Blake Feldman
- Study performed at MetroHealth Medical Center, an affiliate of Case Western Reserve University School of Medicine, USA
| | - Margaret Sinkler
- Study performed at MetroHealth Medical Center, an affiliate of Case Western Reserve University School of Medicine, USA
| | - Madison Connelly
- Study performed at MetroHealth Medical Center, an affiliate of Case Western Reserve University School of Medicine, USA
| | - Matthew Hoffa
- Study performed at MetroHealth Medical Center, an affiliate of Case Western Reserve University School of Medicine, USA
| | - Megen Simpson
- Study performed at MetroHealth Medical Center, an affiliate of Case Western Reserve University School of Medicine, USA
| | - Sarah B Hendrickson
- Study performed at MetroHealth Medical Center, an affiliate of Case Western Reserve University School of Medicine, USA
| | - Heather A Vallier
- Study performed at MetroHealth Medical Center, an affiliate of Case Western Reserve University School of Medicine, USA.
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Ortiz D, Perkins AJ, Fuchita M, Gao S, Holler E, Meagher AD, Mohanty S, French DD, Lasiter S, Khan B, Boustani M, Zarzaur B. Pre-Existing Anxiety and Depression in Injured Older Adults: An Under-Recognized Comorbidity With Major Health Implications. ANNALS OF SURGERY OPEN 2022; 3:e217. [PMID: 36590891 PMCID: PMC9780044 DOI: 10.1097/as9.0000000000000217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/25/2022] [Indexed: 01/03/2023] Open
Abstract
To compare differences in baseline depression and anxiety screenings between older injured patients with pre-existing diagnoses and those without. Background Little is known about the prevalence and impact of psychiatric comorbidities on early postinjury depression and anxiety in nonneurologically injured older adults. Methods This was a retrospective post-hoc analysis of data from the Trauma Medical Home, a multicenter randomized controlled trial (R01AG052493-01A1) that explored the effect of a collaborative care model on postinjury recovery for older adults compared to usual care. Results Nearly half of the patients screened positive for at least mild depressive symptoms as measured by the Patient Health Questionnaire-9. Forty-one percent of the patients screened positive for at least mild anxiety symptoms as measured by the Generalized Anxiety Disorder Scale. Female patients with a history of concurrent anxiety and depression, greater injury severity scores, and higher Charlson scores were more likely to have mild anxiety at baseline assessment. Patients with a history of depression only, a prior history of depression and concurrent anxiety, and higher Charlson scores (greater medical comorbidity) had greater odds of at least mild depression at the time of hospital discharge after traumatic injury. Conclusions Anxiety and depression are prevalent in the older adult trauma population, and affect women disproportionately. A dual diagnosis of depression and anxiety is particularly morbid. Mental illness must be considered and addressed with the same importance as other medical diagnoses in patients with injuries.
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Affiliation(s)
- Damaris Ortiz
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
- Sidney and Lois Eskenazi Hospital Smith Level One Trauma Center, Indianapolis, IN
| | - Anthony J Perkins
- Center of Health Innovation and Implementation Science, Center for Translational Science and Innovation, Indianapolis, IN
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN
| | - Mikita Fuchita
- Division of Critical Care, Department of Anesthesiology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO
| | - Sujuan Gao
- Center of Health Innovation and Implementation Science, Center for Translational Science and Innovation, Indianapolis, IN
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN
| | - Emma Holler
- Department of Epidemiology and Biostatistics, Indiana University, Bloomington, IN
| | - Ashley D Meagher
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
- Indiana University Health, Methodist Hospital Level One Trauma Center, Indianapolis, IN
| | - Sanjay Mohanty
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
- Indiana University Health, Methodist Hospital Level One Trauma Center, Indianapolis, IN
| | - Dustin D French
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Veterans Affairs Health Services Research and Development Service, Chicago, IL
| | - Sue Lasiter
- School of Nursing and Health Studies, Health Sciences District, University of Missouri, Kansas City, MO
| | - Babar Khan
- Sidney and Lois Eskenazi Hospital Smith Level One Trauma Center, Indianapolis, IN
- Center of Health Innovation and Implementation Science, Center for Translational Science and Innovation, Indianapolis, IN
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Malaz Boustani
- Center of Health Innovation and Implementation Science, Center for Translational Science and Innovation, Indianapolis, IN
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Ben Zarzaur
- Department of Surgery, University of Wisconsin School of Medicine, Madison, WI
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Obuobi-Donkor G, Oluwasina F, Nkire N, Agyapong VI. A Scoping Review on the Prevalence and Determinants of Post-Traumatic Stress Disorder among Military Personnel and Firefighters: Implications for Public Policy and Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1565. [PMID: 35162587 PMCID: PMC8834704 DOI: 10.3390/ijerph19031565] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Firefighters and military personnel are public safety personnel who protect the safety of individuals and their properties. They are usually exposed to traumatic events leaving them at risk of developing mental health conditions such as post-traumatic stress disorder (PTSD). Increasing concern is being raised regarding the mental health impacts, specifically PTSD, among military personnel and firefighters. OBJECTIVE There is an increased exposure of firefighters and military personnel to traumatic events and the attendant risk of developing post-traumatic stress disorder. It is crucial to ascertain the level of PTSD amongst this cohort and determinants to formulate policies and practices that mitigate the risk and protect public safety personnel. This scoping review sought to determine the prevalence of PTSD among this cohort globally and to explore determinants of this mental health condition. METHODS A literature search in databases including MEDLINE, CINAHL, PubMed, PsycINFO, and EMBASE was conducted electronically from May 2021 to 31 July 2021. Two reviewers independently assessed full-text articles according to the predefined inclusion criteria and screening process undertaken to identify studies for the review. Articles were screened with a third reviewer, resolving conflicts where necessary and further assessing them for eligibility. During article selection, the PRISMA checklist was adopted, and with the Covidence software, a total of 32 articles were selected for the final examination. For the eligible studies, data extraction was conducted, information was collated and summarized, and the findings were reported. Original qualitative and quantitative data on the prevalence and predictors of PTSD among veterans, military, and firefighters were reported. RESULTS The prevalence of PTSD was 57% for firefighters and 37.8% for military personnel. Demographic factors, job factors, social support, injuries, physical and psychological factors, and individual traits were the main predictors of PTSD in this cohort. CONCLUSION This information is vital for developing and implementing prevention and intervention strategies for PTSD in military personnel and firefighters. Recognizing and addressing factors that predict PTSD will help to improve mental wellbeing and increase productivity. More peer-reviewed studies are needed on the prevalence of PTSD amongst these cohorts.
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Affiliation(s)
- Gloria Obuobi-Donkor
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (F.O.); (N.N.); (V.I.A.)
| | - Folajinmi Oluwasina
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (F.O.); (N.N.); (V.I.A.)
| | - Nnamdi Nkire
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (F.O.); (N.N.); (V.I.A.)
| | - Vincent I.O. Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (F.O.); (N.N.); (V.I.A.)
- Department of Psychiatry, Dalhousie University, Halifax, NS B3H 2E2, Canada
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11
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King C, Collins D, Patten A, Nicolaidis C, Englander H. Trust in Hospital Physicians Among Patients With Substance Use Disorder Referred to an Addiction Consult Service: A Mixed-methods Study. J Addict Med 2022; 16:41-48. [PMID: 33577229 PMCID: PMC8349928 DOI: 10.1097/adm.0000000000000819] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Trust is essential in patient-physician relationships. Hospitalized patients with substance use disorders (SUDs) often experience stigma and trauma in the hospital, which can impede trust. Little research has explored the role of hospital-based addictions care in creating trusting relationships with patients with SUDs. This study describes how trust in physicians changed among hospitalized people with SUDs who were seen by an interprofessional addiction medicine service. METHODS We analyzed data from hospitalized patients with SUD seen by an addiction consult service from 2015 to 2018. Participants completed surveys at baseline and 30 to 90 days after hospital discharge. Follow-up assessments included open-ended questions exploring participant experiences with hospitalization and the addiction consult service. We measured provider trust using the Wake Forest Trust scale. We modeled trust trajectories using discrete mixture modeling, and sampled qualitative interviews from those trust trajectories. RESULTS Of 328 participants with SUD who had prior hospitalizations but had not previously been seen by an addiction consult service, 196 (59.8%) had both baseline and follow-up trust scores. We identified 3 groups of patients: Persistent-Low Trust, Increasing Trust, and Persistent-High Trust and 4 qualitative themes around in-hospital trust: humanizing care, demonstrating addiction expertise, reliability, and granting agency. CONCLUSIONS Most participants retained or increased to high trust levels after hospitalization with an addiction consult service. Addiction consult services can create environments where healthcare providers build trust with, and humanize care for, hospitalized patients with SUD, and can also mitigate power struggles that hospitalized patients with SUD frequently experience.
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Affiliation(s)
- Caroline King
- Department of Biomedical Engineering, School of Medicine, Oregon Health & Science University, Portland, OR
- MD/PhD Program, School of Medicine, Oregon Health & Science University, Portland, OR
| | | | - Alisa Patten
- Department of Medicine, Oregon Health & Science University
| | - Christina Nicolaidis
- Department of Medicine, Oregon Health & Science University
- School of Social Work, Portland State University
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12
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Systematic Review of the Association Between Trauma Severity and Postinjury Symptoms of Depression. World J Surg 2022; 46:2900-2909. [PMID: 36175650 PMCID: PMC9636287 DOI: 10.1007/s00268-022-06750-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Greater symptoms of depression are associated with greater symptom intensity during recovery from musculoskeletal injury. It is not clear that more severe trauma is associated with greater symptoms of depression as one might expect. The goal of this study was to systematically review the existing evidence regarding the association of Injury Severity Score (ISS) with symptoms of depression during recovery from musculoskeletal injury. METHODS Two independent reviewers used PubMed and Embase to identify studies that measured both ISS and symptoms of depression. Among the 17 studies satisfying inclusion criteria, 5 studies assessed the correlation of symptoms of depression and ISS on their continuum; 3 studies compared the mean of symptoms of depression for people above and below a specific ISS level; five compared mean ISS above and below a threshold level of symptoms of depression; and four compared dichotomized ISS and dichotomized depression. Four of the 17 evaluated factors associated with symptoms of depression in multivariable analysis. RESULTS In bivariate analysis, 12 of 17 studies (71%) found no association between ISS level and symptoms of depression. Three studies found a bivariate association that did not persist in multivariable analysis. Two studies reported slight associations in bivariate analysis, but did not perform multivariable analysis. CONCLUSIONS The knowledge that symptoms of depression are common during recovery, in combination with the finding of this review that they have little or no relationship with injury severity, directs clinicians to anticipate and address mental health during recovery from physical trauma of any severity.
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Palinkas LA, Engstrom A, Whiteside L, Moloney K, Zatzick D. A Rapid Ethnographic Assessment of the Impact of the COVID-19 Pandemic on Mental Health Services Delivery in an Acute Care Medical Emergency Department and Trauma Center. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 49:157-167. [PMID: 34319464 PMCID: PMC8317683 DOI: 10.1007/s10488-021-01154-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 01/25/2023]
Abstract
A rapid ethnographic assessment of delivery of mental health services to patients at a Level I trauma center in a major metropolitan hospital undergoing a COVID-19 surge was conducted to assess the challenges involved in services delivery and to compare the experience of delivering services across time. Study participants were patients and providers who interacted with or otherwise were observed by three clinicians engaged in the delivery of care within the Emergency Department (ED) and Trauma Center at Harborview Medical Center from the COVID-19-related "surge" in April to the end of July 2020. Data were collected and analyzed in accordance with the Rapid Assessment Procedures-Informed Clinical Ethnography (RAPICE) protocol. Community and institutional efforts to control the spread of the coronavirus created several challenges to providing mental health services in an acute care setting during the April surge. Most of these challenges were successfully addressed by standardization of infection control protocols, but new challenges emerged including an increase in expenses for infection control and reduction in clinical revenues due to fewer patients, furloughs of mental health services providers and peer specialists in the ED, services not provided or delayed, increased stress due to fear of furloughs or increased workload of those not furloughed, and increases in patients seen with injuries due to risky behavior, violence, and substance use. These findings illustrate the rapidly shifting nature of the pandemic, its impacts on mental health services, and the mitigation efforts of communities and healthcare systems.
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Affiliation(s)
- Lawrence A Palinkas
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W. 34th Street, Los Angeles, CA, 90089-0411, USA.
| | - Allison Engstrom
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Lauren Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, WA, USA.,Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Kathleen Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.,Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, WA, USA
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14
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Fitzgerald JM, Chesney SA, Lee TS, Brasel K, Larson CL, Hillard CJ, deRoon-Cassini TA. Circulating endocannabinoids and prospective risk for depression in trauma-injury survivors. Neurobiol Stress 2021; 14:100304. [PMID: 33614866 PMCID: PMC7876629 DOI: 10.1016/j.ynstr.2021.100304] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/19/2021] [Accepted: 01/30/2021] [Indexed: 12/19/2022] Open
Abstract
Biological mechanisms associated with response to trauma may impact risk for depression. One such mechanism is endocannabinoid signaling (eCB), a neuromodulatory system comprised of the CB1 subtype of cannabinoid receptors (CB1R), encoded by the CNR1 gene, and two primary endogenous ligands: 2-arachidonoylglycerol (2-AG) and N-arachidonylethanolamine (AEA), hydrolyzed by monoacylglycerol lipase (gene name MGLL) and fatty acid amide hydrolase (gene name FAAH). Preclinical data suggest that eCB/CB1R signaling acts as a stress buffer and its loss or suppression increases depression-like behaviors. We examined circulating concentrations of the eCBs (2-AG and AEA) days and six months after a traumatic injury as a marker of eCB/CB1R signaling and as predictors of Center for Epidemiologic Studies of Depression Scale-Revised [CESD-R] scores as a measure of depression severity six months after injury. We also explored associations of CNR1, FAAH, and MGLL genetic variance with depression severity at six months. Results from hierarchical multiple linear regressions showed that higher 2-AG serum concentrations after trauma predicted greater depression at six months (β = 0.23, p = 0.007); neither AEA after trauma, nor 2-AG and AEA at six months were significant predictors (p's > 0.305). Carriers of minor allele for the putative single nucleotide polymorphism in the CNR1 gene rs806371 (β = 0.19, p = 0.024) experienced greater depression at six months. These data suggest that the eCB signaling system is highly activated following trauma and that eCB/CB1R activity contributes to long-term depression risk.
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Affiliation(s)
| | - Samantha A. Chesney
- Froedtert Memorial Lutheran Hospital - Neurological Rehabilitation Services, Milwaukee, WI, USA
| | | | - Karen Brasel
- Oregon Health & Science University, Portland, OR, USA
| | - Christine L. Larson
- University of Wisconsin – Milwaukee, Department of Psychology, Milwaukee, WI, USA
| | - Cecilia J. Hillard
- Medical College of Wisconsin, Neuroscience Research Center and Department of Pharmacology and Toxicology, Milwaukee, WI, USA
| | - Terri A. deRoon-Cassini
- Medical College of Wisconsin, Department of Surgery, Division of Trauma & Acute Care Surgery, Milwaukee, WI, USA
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15
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Understanding trajectories of underlying dimensions of posttraumatic psychopathology. J Affect Disord 2021; 284:75-84. [PMID: 33588239 PMCID: PMC7927420 DOI: 10.1016/j.jad.2021.01.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/12/2021] [Accepted: 01/31/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Research suggests four modal trajectories of psychological symptoms after traumatic injury: Resilient, Chronic, Delayed Onset, Recovery. However, most studies focus on symptoms of psychiatric disorders (e.g., posttraumatic stress disorder, depression), which are limited by heterogeneity and symptom overlap. We examined trajectories of cross-cutting posttraumatic symptom dimensions following traumatic injury and predictors of trajectory membership. METHODS In this longitudinal study of 427 predominantly Hispanic/Latino traumatic injury survivors, posttraumatic psychopathology symptoms were assessed during hospitalization and approximately one and five months post-trauma. Using latent class growth analysis, we estimated trajectories of several posttraumatic symptom dimensions: re-experiencing, avoidance, anxious arousal, numbing, dysphoric arousal, loss, and threat. We then examined sociodemographic and trauma-related characteristics (measured during hospitalization) as predictors of trajectory membership for each dimension. RESULTS Four trajectories (Resilient, Chronic, Delayed Onset, Recovery) emerged for all dimensions except loss and threat, which manifested three trajectories (Resilient, Chronic, Delayed Onset). Across dimensions, membership in the Chronic (vs. Resilient) trajectory was consistently predicted by unemployment (7 of 7 dimensions), followed by older age (3/7), female sex (3/7), and assaultive trauma (2/7). For several dimensions, unemployment also distinguished between participants who presented with similar symptom levels days after trauma, but then diverged over time. LIMITATIONS Measures of posttraumatic symptom dimension constructs differed across assessments. CONCLUSIONS This study provides evidence of distinct trajectories across transdiagnostic symptom dimensions after traumatic injury. Employment status emerged as the most important predictor of trajectory membership. Research is needed to better understand the etiologies and consequences of these posttraumatic symptom dimension trajectories.
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16
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Hay D, Jamal MS, Al-Tawil K, Petohazi A, Gulli V, Bednarczuk NF, Baldwin-Smith R, Gibbons J, Sinha J. The effect of the COVID-19 pandemic on mental health associated trauma, admissions and fractures at a London major trauma centre. Ann R Coll Surg Engl 2021; 103:114-119. [PMID: 33559558 PMCID: PMC9773921 DOI: 10.1308/rcsann.2020.7026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Non-injury-related factors have been extensively studied in major trauma and have been shown to have a significant impact on patient outcomes. Mental illness and associated medication use has been proven to have a negative effect on bone health and fracture healing. MATERIALS AND METHODS We collated data retrospectively from the records of orthopaedic inpatients in a non-COVID and COVID period. We analysed demographic data, referral and admission numbers, orthopaedic injuries, surgery performed and patient comorbidities, including psychiatric history. RESULTS There were 824 orthopaedic referrals and 358 admissions (six/day) in the non-COVID period, with 38/358 (10.6%) admissions having a psychiatric diagnosis and 30/358 (8.4%) also having a fracture. This was compared with 473 referrals and 195 admissions (three/day) in the COVID period, with 73/195 (37.4%) admissions having a documented psychiatric diagnosis and 47/195 (24.1%) having a fracture. DISCUSSION There was a reduction in the number of admissions and referrals during the pandemic, but a simultaneous three-fold rise in admissions with a psychiatric diagnosis. The proportion of patients with both a fracture and a psychiatric diagnosis more than doubled and the number of patients presenting due to a traumatic suicide attempt almost tripled. CONCLUSION While total numbers using the orthopaedic service decreased, the impact of the pandemic and lockdown disproportionately affects those with mental health problems, a group already at higher risk of poorer functional outcomes and non-union. It is imperative that adequate support is in place for patients with vulnerable mental health during these periods, particularly as we look towards a potential 'second wave' of COVID-19.
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Affiliation(s)
- D Hay
- Department of Trauma and Orthopaedic Surgery, Kings College Hospital NHS Foundation Trust, London, UK
| | - MS Jamal
- Department of Trauma and Orthopaedic Surgery, Kings College Hospital NHS Foundation Trust, London, UK
| | - K Al-Tawil
- Department of Trauma and Orthopaedic Surgery, Kings College Hospital NHS Foundation Trust, London, UK
| | - A Petohazi
- Department of Trauma and Orthopaedic Surgery, Kings College Hospital NHS Foundation Trust, London, UK
| | - V Gulli
- Department of Trauma and Orthopaedic Surgery, Kings College Hospital NHS Foundation Trust, London, UK
| | - NF Bednarczuk
- Department of Trauma and Orthopaedic Surgery, Kings College Hospital NHS Foundation Trust, London, UK
| | - R Baldwin-Smith
- Department of Trauma and Orthopaedic Surgery, Kings College Hospital NHS Foundation Trust, London, UK
| | - J Gibbons
- GKT School of Medical Education, Kings College London, London, UK
| | - J Sinha
- Department of Trauma and Orthopaedic Surgery, Kings College Hospital NHS Foundation Trust, London, UK
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Kendrick D, das Nair R, Kellezi B, Morriss R, Kettlewell J, Holmes J, Timmons S, Bridger K, Patel P, Brooks A, Hoffman K, Radford K. Vocational rehabilitation to enhance return to work after trauma (ROWTATE): protocol for a non-randomised single-arm mixed-methods feasibility study. Pilot Feasibility Stud 2021; 7:29. [PMID: 33472707 PMCID: PMC7816441 DOI: 10.1186/s40814-021-00769-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 01/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background Traumatic injuries are common amongst working-age adults. Survivors often experience physical and psychological problems, reduced quality of life and difficulty returning to work. Vocational rehabilitation improves work outcomes for a range of conditions but evidence of effectiveness for those with traumatic injuries is lacking. This study assesses feasibility of delivering a vocational rehabilitation intervention to enhance return to work and improve quality of life and wellbeing in people with at least moderate trauma to inform design of a definitive randomised controlled trial (RCT). Methods Non-randomised, single-arm, multi-centre mixed-methods feasibility study with nested case studies and qualitative study. The case studies comprise interviews, observations of clinical contacts and review of clinical records. The qualitative study comprises interviews and/or focus groups. Participants will be recruited from two UK major trauma centres. Participants will comprise 40 patients aged 16–69 with an injury severity score of > 8 who will receive the intervention and complete questionnaires. Interviews will be conducted with 10 patients and their occupational therapists (OTs), clinical psychologists (CPs), employers and commissioners of rehabilitation services. Fidelity will be assessed in up to six patients by observations of OT and CP—patient contacts, review of patient records and intervention case report forms. OT and CP training will be evaluated using questionnaires and competence to deliver the intervention assessed using a team objective structured clinical examination and written task. Patients participating in and those declining participation in the study will be invited to take part in interviews/focus groups to explore barriers and facilitators to recruitment and retention. Outcomes include recruitment and retention rates, intervention fidelity, OT and CP competence to deliver the intervention, experiences of delivering or receiving the intervention and factors likely to influence definitive trial delivery. Discussion Effective vocational rehabilitation interventions to enhance return to work amongst trauma patients are urgently needed because return to work is often delayed, with detrimental effects on health, financial stability, healthcare resource use and wider society. This protocol describes a feasibility study delivering a complex intervention to enhance return to work in those with at least moderate trauma. Trial registration ISRCTN: 74668529. Prospectively registered on 23 January 20
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Affiliation(s)
- Denise Kendrick
- School of Medicine, University Park, Floor 13, Tower Building, Nottingham, NG7 2RD, UK.
| | - Roshan das Nair
- School of Medicine, Institute of Mental Health, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB, UK
| | - Blerina Kellezi
- Division of Psychology, School of Social Sciences, Nottingham Trent University, Burton Street, Nottingham, NG1 4BU, UK
| | - Richard Morriss
- School of Medicine, Institute of Mental Health, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB, UK
| | - Jade Kettlewell
- Centre for Health Innovation, Leadership and Learning, Nottingham University Business School, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB, UK
| | - Jain Holmes
- School of Medicine, Medical School, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Stephen Timmons
- Centre for Health Innovation, Leadership and Learning, Nottingham University Business School, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB, UK
| | - Kay Bridger
- School of Medicine, University Park, Floor 13, Tower Building, Nottingham, NG7 2RD, UK
| | - Priya Patel
- Centre for Trauma Sciences, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark St, London, E1 2AT, UK
| | - Adam Brooks
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, UK
| | - Karen Hoffman
- Centre for Trauma Sciences, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark St, London, E1 2AT, UK
| | - Kathryn Radford
- School of Medicine, Medical School, Queen's Medical Centre, Nottingham, NG7 2UH, UK
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Hegy JK, Brog NA, Berger T, Znoj H. Web-based Self-help Program for Adjustment Problems After an Accident (SelFIT): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e21200. [PMID: 33331830 PMCID: PMC7775196 DOI: 10.2196/21200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/12/2020] [Accepted: 11/10/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Accidents and the resulting injuries are among the world's biggest health care issues, often causing long-term effects on psychological and physical health. With regard to psychological consequences, accidents can cause a wide range of burdens including adjustment problems. Although adjustment problems are among the most frequent mental health problems, there are few specific interventions available. The newly developed program SelFIT (German acronym: Selber wieder fit nach einem Unfall; "fit again after an accident") aims to remedy this situation by offering a low-threshold, web-based self-help intervention for psychological distress after an accident. OBJECTIVE The overall aim is to evaluate the efficacy and cost-effectiveness of the SelFIT program plus care as usual (CAU) compared to only CAU. Furthermore, the program's user-friendliness, acceptance, and adherence are assessed. We expect that the use of SelFIT will be associated with a greater reduction in psychological distress, greater improvement in mental and physical well-being, and greater cost-effectiveness compared to CAU. METHODS Adults (n=240) experiencing adjustment problems due to an accident they had between 2 weeks and 2 years before entering the study will be randomized into either the intervention or control group. Participants in the intervention group receive direct access to SelFIT. The control group receives access to the program after 12 weeks. There are 6 measurement points for both groups (baseline as well as after 4, 8, 12, 24, and 36 weeks). The main outcome is a reduction in anxiety, depression, and stress symptoms that indicate adjustment problems. Secondary outcomes include well-being, optimism, embitterment, self-esteem, self-efficacy, emotion regulation, pain, costs of health care consumption, and productivity loss, as well as the program's adherence, acceptance, and user-friendliness. RESULTS Recruitment began in December 2019 and will continue at least until January 2021, with the option to extend this for another 6 months until July 2021. As of July 2020, 324 people have shown interest in participating, and 48 people have given their informed consent. CONCLUSIONS To the best of our knowledge, this is the first study examining a web-based self-help program designed to treat adjustment problems resulting from an accident. If effective, the program could complement the still limited offerings for secondary and tertiary prevention of psychological distress after an accident. TRIAL REGISTRATION ClinicalTrials.gov NCT03785912; https://clinicaltrials.gov/ct2/show/NCT03785912. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/21200.
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Affiliation(s)
- Julia Katharina Hegy
- Department of Health Psychology and Behavioral Medicine, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Noemi Anja Brog
- Department of Health Psychology and Behavioral Medicine, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Hansjoerg Znoj
- Department of Health Psychology and Behavioral Medicine, Institute of Psychology, University of Bern, Bern, Switzerland
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Meneses E, Kinslow K, McKenney M, Elkbuli A. Post-Traumatic Stress Disorder in Adult and Pediatric Trauma Populations: A Literature Review. J Surg Res 2020; 259:357-362. [PMID: 33070994 DOI: 10.1016/j.jss.2020.09.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/25/2020] [Accepted: 09/22/2020] [Indexed: 01/30/2023]
Abstract
Each year, traumatic injuries affect 2.6 million adults in the United States leading to significant health problems. Although many sequelae stem directly from physical manifestations of one's sustained injuries, mental health may also be affected in the form of post-traumatic stress disorder (PTSD). PTSD can lead to decreased physical recovery, social functioning, and quality of life. Several screening tools such as the Injured Trauma Survivor Screen, PTSD CheckList, Primary Care PTSD, and Clinician-Administered PTSD Scale for DSM-5 have been used for initial PTSD screening of the trauma patient. Early screening is important as it serves as the first step in delivering the appropriate mental health care to those in need. Factors that increase the likelihood of developing PTSD include younger age, nonwhite ethnicity, and lower socioeconomic status. Current data on male or female predominance of PTSD in trauma populations is inconsistent. Cognitive behavioral therapy, hypnosis, and psychoeducation have been used to treat symptoms of PTSD. This review discusses the impact PTSD has on the trauma patient and the need for universal screening in this susceptible population. Ultimately, trauma centers should implement such universal screening protocols as to avoid absence, or undertreatment of PTSD, both of which having longstanding consequences.
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Affiliation(s)
- Evander Meneses
- Division of Trauma and Surgical Critical Care, Department of Surgery, Kendall Regional Medical Center, Miami, Florida
| | - Kyle Kinslow
- Division of Trauma and Surgical Critical Care, Department of Surgery, Kendall Regional Medical Center, Miami, Florida
| | - Mark McKenney
- Division of Trauma and Surgical Critical Care, Department of Surgery, Kendall Regional Medical Center, Miami, Florida; Department of Surgery, University of South Florida, Tampa, Florida
| | - Adel Elkbuli
- Division of Trauma and Surgical Critical Care, Department of Surgery, Kendall Regional Medical Center, Miami, Florida.
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20
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Shahrour G, Dardas LA. Acute stress disorder, coping self-efficacy and subsequent psychological distress among nurses amid COVID-19. J Nurs Manag 2020; 28:1686-1695. [PMID: 32767827 PMCID: PMC7436502 DOI: 10.1111/jonm.13124] [Citation(s) in RCA: 133] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/28/2020] [Accepted: 08/03/2020] [Indexed: 12/19/2022]
Abstract
Purpose Health care professionals, particularly nurses, are considered a vulnerable group to experience acute stress disorder (ASD) and subsequent psychological distress amid COVID‐19 pandemic. This study aims to establish the prevalence of acute stress disorder and predictors of psychological distress among Jordanian nurses. Methods A quantitative, cross‐sectional, descriptive and comparative design was used. Data were collected using a Web‐based survey. A total of 448 Jordanian nurses (73% females) completed and returned the study questionnaire. Results The majority of nurses (64%) are experiencing ASD due to the COVID‐19 pandemic and thus are at risk for PTSD predisposition. More than one‐third of nurses (41%) are also suffering significant psychological distress. Among our sample, age, ASD and coping self‐efficacy significantly predicted psychological distress. More specifically, younger nurses are more prone to experience psychological distress than older ones. While higher scores on ASD showed more resultant psychological distress, coping self‐efficacy was a protective factor. Conclusion Given that individuals who suffer from ASD are predisposed to PTSD, follow‐up with nurses to screen for PTSD and referral to appropriate psychological services is pivotal. Coping self‐efficacy is found to ameliorate the effect of psychological distress on nurses' traumatic experience. Such findings warrant intensive efforts from health care institutions to provide psychosocial support services for nurses and ongoing efforts to screen them for traumatic and psychological distress symptoms. Implications for Nursing Management Nursing leaders and managers are in the forefront of responding to the unique needs of their workforces during the COVID‐19 crisis. They need to implement stress‐reduction strategies for nurses through providing consecutive rest days, rotating allocations of complex patients, arranging support services and being accessible to staff. They also need to ensure nurses' personal safety through securing and providing personal safety measures and undertake briefings to ensure their staff's physical and mental well‐being, as well as providing referrals to appropriate psychological services.
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Affiliation(s)
- Ghada Shahrour
- School of Nursing, Jordan University of Science and Technology, Irbid, Jordan
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A Survey of Trauma Surgeon Perceptions of Resources for Patients With Psychiatric Comorbidities. J Surg Res 2020; 256:31-35. [PMID: 32683053 DOI: 10.1016/j.jss.2020.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 04/04/2020] [Accepted: 06/16/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Psychiatric illness is an independent risk factor for trauma and recidivism and is often comorbid in the trauma population. There is no current standard for the delivery of mental health services in trauma care. The purpose of this study was to gauge trauma surgeon perceptions of needed and currently available resources for this patient population at level 1 trauma centers in the United States. MATERIALS AND METHODS A 10-question survey was developed to capture the estimated volume of psychiatric patients admitted to level 1 trauma centers, their available psychiatric services, and perceived need for resources. It was sent to 27 trauma surgery colleagues at different level 1 trauma centers across the United States using a public survey tool. Descriptive analyses were performed. RESULTS Twenty-two of 27 trauma surgeons responded (81% response rate). Ten centers (48%) estimated admitting 1-5 patients with preexisting serious mental illness weekly, whereas others admitted more. Eight (36%) reported not having acute situational support services available. Ten respondents (46%) did not know how many psychiatric consultants were available at their institution. Twelve surgeons (55%) reported no designated outpatient follow-up for psychiatric issues. Sixteen trauma surgeons (73%) stated that expanded psychiatric services are needed at their trauma center. CONCLUSIONS Trauma patients frequently present with preexisting serious mental illness and many struggle with psychological sequelae of trauma. Over half of the surveyed surgeons reported no outpatient follow-up for these patients, and almost three quarters perceived the need for expansion of psychiatric services. In addition to a lack of resources, these findings highlight an overlooked gap in high-quality patient-centered trauma care.
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Ortiz D, Meagher AD, Lindroth H, Holler E, Gao S, Khan B, Lasiter S, Boustani M, Zarzaur B. A trauma medical home, evaluating collaborative care for the older injured patient: study protocol for a randomized controlled trial. Trials 2020; 21:655. [PMID: 32678026 PMCID: PMC7364470 DOI: 10.1186/s13063-020-04582-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/04/2020] [Indexed: 04/11/2023] Open
Abstract
Background It is estimated that 55 million adults will be 65 years and older in the USA by 2020. These older adults are at increased risk for injury and their recovery is multi-faceted. A collaborative care model may improve psychological and functional outcomes of the non-neurologically impaired older trauma patient and reduce health care costs. Methods This is a randomized controlled trial of 430 patients aged 50 and older who have suffered a non-neurologic injury and are admitted to a level one trauma center in Indianapolis, IN, or Madison, WI. Participants will be assigned to either the Trauma Medical Home (TMH) intervention or usual care. The TMH intervention is a collaborative care model that includes validated protocols addressing the multi-faceted needs of this population, with the help of care coordination software and a mobile office concept. The primary outcome is self-reported physical recovery at 6- and 12-month follow-up. Secondary outcomes include self-reported psychological recovery, acute health care utilization, and cost-effectiveness of the intervention at 6 and 12 months. The TMH collaborative care model will be delivered by a registered nurse care coordinator. The assessments will be completed by trained blinded research assistants. Discussion The proposed study will evaluate a collaborative care model to help maximize psychological and functional recovery for non-neurologically injured older patients at four level one trauma centers in the Midwest. Trial registration Clinical Trials. NCT03108820. Registered on 11 April 2017. Protocol Version 6: Study # 1612690852. April 12, 2019. Sponsor: Indiana University. Human subjects and IRB contact information: irb@iu.edu Prospectively registered in the WHO ICTRP on 4 June 2017.
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Affiliation(s)
- Damaris Ortiz
- Division of Acute Care Surgery, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., Emerson Hall, Indianapolis, IN, 46202, USA. .,Sidney & Lois Eskenazi Hospital Smith Level One Trauma Center, 720 Eskenazi Ave, Indianapolis, IN, 46202, USA.
| | - Ashley D Meagher
- Division of Acute Care Surgery, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., Emerson Hall, Indianapolis, IN, 46202, USA.,Indiana University Health, Methodist Hospital Level One Trauma Center, 1701 Senate Ave, Indianapolis, IN, 46202, USA
| | - Heidi Lindroth
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, 1120 W. Michigan St., CL 260, Indianapolis, IN, 46202, USA.,Center of Health Innovation and Implementation Science, Center for Translational Science and Innovation, 410 W. 10th St., Indianapolis, IN, 46202, USA.,Indiana University Center of Aging Research, Regenstrief Institute, 1101 W. 10th St., Indianapolis, IN, 46202, USA
| | - Emma Holler
- Sidney & Lois Eskenazi Hospital Smith Level One Trauma Center, 720 Eskenazi Ave, Indianapolis, IN, 46202, USA
| | - Sujuan Gao
- Center of Health Innovation and Implementation Science, Center for Translational Science and Innovation, 410 W. 10th St., Indianapolis, IN, 46202, USA
| | - Babar Khan
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, 1120 W. Michigan St., CL 260, Indianapolis, IN, 46202, USA.,Center of Health Innovation and Implementation Science, Center for Translational Science and Innovation, 410 W. 10th St., Indianapolis, IN, 46202, USA.,Indiana University Center of Aging Research, Regenstrief Institute, 1101 W. 10th St., Indianapolis, IN, 46202, USA
| | - Sue Lasiter
- School of Nursing and Health Studies, University of Missouri, 2464 Charlotte St, Kansas City, MO, 64108, USA
| | - Malaz Boustani
- Center of Health Innovation and Implementation Science, Center for Translational Science and Innovation, 410 W. 10th St., Indianapolis, IN, 46202, USA.,Indiana University Center of Aging Research, Regenstrief Institute, 1101 W. 10th St., Indianapolis, IN, 46202, USA
| | - Ben Zarzaur
- Department of Surgery, University of Wisconsin School of Medicine and Public Health-Madison, 600 Highland Ave., Madison, WI, 53792, USA
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Boals A, Trost Z, Warren AM, McShan EE. Injustice is Served: Injustice Mediates the Effects of Interpersonal Physical Trauma on Posttraumatic Stress Symptoms and Depression Following Traumatic Injury. J Trauma Stress 2020; 33:201-207. [PMID: 32216147 DOI: 10.1002/jts.22495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 08/05/2019] [Accepted: 08/09/2019] [Indexed: 11/11/2022]
Abstract
Previous research has consistently found that traumas of an interpersonal nature are associated with elevated levels of posttraumatic stress symptoms (PTSS). In the current study, we examined whether feelings of injustice related to sustained physical trauma mediate the association between the interpersonal nature of a traumatic injury and two outcomes: PTSS and depressive symptoms. The sample consisted of 176 patients admitted to a Level 1 trauma center for traumatic injuries. Participants completed measures of PTSS, depressive symptoms, and injury-related injustice perception at baseline and again at 3- and 6-month postinjury follow-ups. The results revealed that, compared to noninterpersonal injuries, interpersonal injuries were related to significantly higher levels of perceived injustice, PTSS, and depressive symptoms at all three assessment points, except for PTSS at baseline, ds = 0.47-1.23. These associations remained significant after accounting for injury severity. It is important to note that higher levels of perceived injustice 3-month postinjury follow-up mediated the association between the interpersonal nature of the trauma and higher levels of PTSS and depressive symptoms at 6 months postinjury. Our results suggest injustice may be an important factor that helps explain why interpersonal traumas are associated with poorer mental health outcomes than noninterpersonal traumas. Additionally, the current study provides some of the first prospective analyses of injustice perception and trauma outcomes.
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Affiliation(s)
- Adriel Boals
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | - Zina Trost
- Department of Psychology, University of Alabama-Birmingham, Birmingham, Alabama, USA
| | - Ann Marie Warren
- Neuropsychology and Rehabilitation Psychology for Baylor Scott & White Health Institute for Rehabilitation, Baylor University Medical Center, Dallas, Texas, USA
| | - Evan E McShan
- Neuropsychology and Rehabilitation Psychology for Baylor Scott & White Health Institute for Rehabilitation, Baylor University Medical Center, Dallas, Texas, USA
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Abstract
OBJECTIVES Examine the effect of different types of firearms on readmission due to acute stress disorder (ASD) and/or post-traumatic stress disorder (PTSD) in firearm-injury victims. BACKGROUND Survivors of firearm-related injuries suffer long-term sequelae such as disability, work loss, and deterioration in the quality of life. There is a paucity of data describing the long-term mental health outcomes in these patients. METHODS We performed a 5-year (2011-2015) analysis of the Nationwide Readmission Database. All adult patients with firearm injuries were stratified into 3 groups by firearm type: handgun, shotgun, and semiautomatic rifle. Outcome measures were the incidence and predictors of ASD/PTSD. RESULTS A total of 100,704 victims of firearm-related injuries were identified, of which 13.3% (n = 13,393) were readmitted within 6 months of index hospitalization, 6.7% (n = 8970) of these due to ASD/PTSD. Mean age was 34 ± 14 years, 88% were men. Of those readmitted due to ASD/PTSD, 24% (n = 2153) sustained a handgun-related injury on index hospitalization, 12% (n = 1076) shotgun, and 64% (n = 5741) semiautomatic gun (P = 0.039). On regression analysis, semiautomatic gun and shotgun victims had higher odds of developing ASD/PTSD upon readmission [odds ratio (OR): 2.05 (1.10-4.12) and OR: 1.41 (1.08-2.11)] compared to handgun. Female sex [OR: 1.79 (1.05-3.05)] and younger age representing those younger than 25 years [OR: 4.66 (1.12-6.74)] were also independently associated with higher odds of ASD/PTSD. CONCLUSIONS Apart from the lives lost, survivors of semiautomatic rifle- and shotgun-related injuries suffer long-term mental health sequalae. These secondary and debilitating mental health outcomes are important considerations for capturing the overall burden of the disease.
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The scales of recovery: Balancing posttraumatic stress with resilience in the violently injured. J Trauma Acute Care Surg 2020; 89:208-214. [DOI: 10.1097/ta.0000000000002622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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McLean SA, Ressler K, Koenen KC, Neylan T, Germine L, Jovanovic T, Clifford GD, Zeng D, An X, Linnstaedt S, Beaudoin F, House S, Bollen KA, Musey P, Hendry P, Jones CW, Lewandowski C, Swor R, Datner E, Mohiuddin K, Stevens JS, Storrow A, Kurz MC, McGrath ME, Fermann GJ, Hudak LA, Gentile N, Chang AM, Peak DA, Pascual JL, Seamon MJ, Sergot P, Peacock WF, Diercks D, Sanchez LD, Rathlev N, Domeier R, Haran JP, Pearson C, Murty VP, Insel TR, Dagum P, Onnela JP, Bruce SE, Gaynes BN, Joormann J, Miller MW, Pietrzak RH, Buysse DJ, Pizzagalli DA, Rauch SL, Harte SE, Young LJ, Barch DM, Lebois LAM, van Rooij SJH, Luna B, Smoller JW, Dougherty RF, Pace TWW, Binder E, Sheridan JF, Elliott JM, Basu A, Fromer M, Parlikar T, Zaslavsky AM, Kessler R. The AURORA Study: a longitudinal, multimodal library of brain biology and function after traumatic stress exposure. Mol Psychiatry 2020; 25:283-296. [PMID: 31745239 PMCID: PMC6981025 DOI: 10.1038/s41380-019-0581-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/26/2019] [Indexed: 11/08/2022]
Abstract
Adverse posttraumatic neuropsychiatric sequelae (APNS) are common among civilian trauma survivors and military veterans. These APNS, as traditionally classified, include posttraumatic stress, postconcussion syndrome, depression, and regional or widespread pain. Traditional classifications have come to hamper scientific progress because they artificially fragment APNS into siloed, syndromic diagnoses unmoored to discrete components of brain functioning and studied in isolation. These limitations in classification and ontology slow the discovery of pathophysiologic mechanisms, biobehavioral markers, risk prediction tools, and preventive/treatment interventions. Progress in overcoming these limitations has been challenging because such progress would require studies that both evaluate a broad spectrum of posttraumatic sequelae (to overcome fragmentation) and also perform in-depth biobehavioral evaluation (to index sequelae to domains of brain function). This article summarizes the methods of the Advancing Understanding of RecOvery afteR traumA (AURORA) Study. AURORA conducts a large-scale (n = 5000 target sample) in-depth assessment of APNS development using a state-of-the-art battery of self-report, neurocognitive, physiologic, digital phenotyping, psychophysical, neuroimaging, and genomic assessments, beginning in the early aftermath of trauma and continuing for 1 year. The goals of AURORA are to achieve improved phenotypes, prediction tools, and understanding of molecular mechanisms to inform the future development and testing of preventive and treatment interventions.
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Affiliation(s)
- Samuel A McLean
- Department of Anesthesiology, Institute of Trauma Recovery, UNC School of Medicine, Chapel Hill, NC, USA.
| | - Kerry Ressler
- Department of Psychiatry, McLean Hospital, Boston, MA, USA
| | | | - Thomas Neylan
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Laura Germine
- Department of Psychiatry, McLean Hospital, Boston, MA, USA
| | - Tanja Jovanovic
- Department of Psychiatry & Behavioral Neuroscience, Wayne State University School of Medicine, Detroit, MI, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA
| | - Donglin Zeng
- Department of Biostatistics, UNC Gillings School of Public Health, Chapel Hill, NC, USA
| | - Xinming An
- Department of Anesthesiology, Institute of Trauma Recovery, UNC School of Medicine, Chapel Hill, NC, USA
| | - Sarah Linnstaedt
- Department of Anesthesiology, Institute of Trauma Recovery, UNC School of Medicine, Chapel Hill, NC, USA
| | - Francesca Beaudoin
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Stacey House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Kenneth A Bollen
- Department of Statistics and Operational Research, University of North Carolina, Chapel Hill, NC, USA
| | - Paul Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Phyllis Hendry
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper University Health Care, Camden, NJ, USA
| | | | - Robert Swor
- Department of Emergency Medicine, William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Elizabeth Datner
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Kamran Mohiuddin
- Department of Emergency Medicine, Einstein Health Medical Center, Philadelphia, PA, USA
| | - Jennifer S Stevens
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Alan Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Christopher Kurz
- Department of Emergency Medicine, School of Medicine, University of Alabama, Birmingham, AL, USA
| | - Meghan E McGrath
- Department of Emergency Medicine, Boston University Medical Center, Boston, MA, USA
| | - Gregory J Fermann
- Department of Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University Hospital, Atlanta, GA, USA
| | - Nina Gentile
- Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Anna Marie Chang
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jose L Pascual
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Mark J Seamon
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School, University of Texas, Houston, TX, USA
| | - W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Deborah Diercks
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Niels Rathlev
- Department of Emergency Medicine, Baystate Medical Center, Springfield, MA, USA
| | - Robert Domeier
- Department of Emergency Medicine, St. Joseph Mercy Ann Arbor Hospital, Ypsilanti, MI, USA
| | - John Patrick Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Vishnu P Murty
- Department of Psychology, College of Liberal Arts, Temple University, Philadelphia, PA, USA
| | | | - Paul Dagum
- Mindstrong Health, Mountain View, CA, USA
| | - Jukka-Pekka Onnela
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri, St. Louis, MO, USA
| | - Bradley N Gaynes
- Department of Psychiatry, UNC School of Medicine, Chapel Hill, NC, USA
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Mark W Miller
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Scott L Rauch
- Department of Psychiatry, McLean Hospital, Boston, MA, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Larry J Young
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Sanne J H van Rooij
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jordan W Smoller
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | - Thaddeus W W Pace
- Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Elisabeth Binder
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - John F Sheridan
- College of Dentistry, Ohio State University School of Medicine, Columbus, OH, USA
| | - James M Elliott
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Archana Basu
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | | | | | - Alan M Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Ronald Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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Specialized concussion clinic referrals are not intended for all acute concussion patients in the emergency department. CAN J EMERG MED 2019; 21:694-697. [DOI: 10.1017/cem.2019.430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Jaramillo S, Suffoletto B, Callaway C, Pacella-LaBarbara M. Early Screening for Posttraumatic Stress Disorder and Depression Among Injured Emergency Department Patients: A Feasibility Study. Acad Emerg Med 2019; 26:1232-1244. [PMID: 31179590 PMCID: PMC7294865 DOI: 10.1111/acem.13816] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/03/2019] [Accepted: 06/05/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite the risk of developing posttraumatic stress disorder (PTSD) and associated comorbidities after physical injury, few emergency departments (EDs) in the United States screen for the presence of psychological symptoms and conditions. Barriers to systematic screening could be overcome by using a tool that is both comprehensive and brief. This study aimed to determine 1) the feasibility of screening for posttraumatic sequelae among adults with minor injury in the ED and 2) the relationship between ED screening and later psychological symptoms and poor quality of life (QOL) at 6 weeks postinjury. METHODS In the EDs of two Level I trauma centers, we enrolled injured patients (n = 149) who reported serious injury and/or life threat in the past 24 hours. Subjects completed the Posttraumatic Adjustment Scale (PAS) to screen for PTSD and depression in the ED, and 6 weeks later they completed assessments for symptoms of PTSD, depression, and trauma-specific QOL (T-QoL). RESULTS Our retained sample at 6 weeks was 84 adults (51.2% male; mean ± SD age = 33 ± 11.88 years); 38% screened positive for PTSD, and 76% screened positive for depression in the ED. Controlling for age, hospital admission, and ED pain score, regression analyses revealed that a positive ED screen for both PTSD and depression was significantly associated with 6 weeks PTSD (p = 0.027, 95% confidence interval [CI] = 0.92 to 15.14) and depressive symptoms (p = 0.001, 95% CI = 2.20 to 7.74), respectively. Further, a positive ED screen for depression (p = 0.043, 95% CI = -16.66 to -0.27) and PTSD (p = 0.015, 95% CI = -20.35 to -2.24) was significantly associated with lower T-QoL. CONCLUSIONS These results suggest that it is feasible to identify patients at risk for postinjury sequelae in the ED; screening for mental health risk may identify patients in need of early intervention and further monitoring.
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Affiliation(s)
- Stephany Jaramillo
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Brian Suffoletto
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Clifton Callaway
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Maria Pacella-LaBarbara
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Roberts AL, Pascual-Leone A, Speizer FE, Zafonte RD, Baggish AL, Taylor H, Nadler LM, Courtney TK, Connor A, Grashow R, Stillman AM, Marengi DA, Weisskopf MG. Exposure to American Football and Neuropsychiatric Health in Former National Football League Players: Findings From the Football Players Health Study. Am J Sports Med 2019; 47:2871-2880. [PMID: 31468987 PMCID: PMC7163246 DOI: 10.1177/0363546519868989] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Former American football players have a higher prevalence of cognitive impairment than that of the US general population. It remains unknown what aspects of playing football are associated with neuropsychiatric outcomes. HYPOTHESIS It was hypothesized that seasons of professional football, playing position, and experience of concussions were associated with cognition-related quality of life (QOL) and indicators of depression and anxiety. STUDY DESIGN Descriptive epidemiology study. METHODS The authors examined whether seasons of professional football, playing position, and experience of concussions, as measured by self-report of 10 symptoms, were associated with cognition-related QOL and indicators of depression and anxiety in a cross-sectional survey conducted 2015 to 2017. Cognition-related QOL was measured by the short form of the Quality of Life in Neurological Disorders: Applied Cognition-General Concerns. The Patient Health Questionnaire-4 measured depression and anxiety symptoms. Of 13,720 eligible men with apparently valid contact information, 3506 players returned a questionnaire at the time of this analysis (response rate = 25.6%). RESULTS Seasons of professional play (risk ratio [RR] per 5 seasons = 1.19, 95% CI = 1.06-1.34) and playing position were associated with cognition-related QOL. Each 5 seasons of play was associated with 9% increased risk of indicators of depression at borderline statistical significance (P = .05). When compared with former kickers, punters, and quarterbacks, men who played any other position had a higher risk of poor cognition-related QOL, depression, and anxiety. Concussion symptoms were strongly associated with poor cognition-related QOL (highest concussion quartile, RR = 22.3, P < .001), depression (highest quartile, RR = 6.0, P < .0001), and anxiety (highest quartile, RR = 6.4, P < .0001), even 20 years after last professional play. CONCLUSION The data suggest that seasons of play and playing position in the NFL are associated with lasting neuropsychiatric health deficits. Additionally, poor cognition-related QOL, depression, and anxiety appear to be associated with concussion in the long term.
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Affiliation(s)
- Andrea L. Roberts
- Andrea L. Roberts, PhD,
Department of Environmental Health, Harvard T.H. Chan School of Public Health,
677 Huntington Ave, Boston, MA 02115, USA (
)
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Johnson L, Lodge C, Vollans S, Harwood PJ. Predictors of psychological distress following major trauma. Injury 2019; 50:1577-1583. [PMID: 31196596 DOI: 10.1016/j.injury.2019.05.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 05/25/2019] [Accepted: 05/30/2019] [Indexed: 02/02/2023]
Abstract
AIM The aim of this study was to identify variables that may predict later psychological distress in patients following admission to a Major Trauma Centre (MTC) and to determine whether a psychological screening tool, the Posttraumatic Adjustment Screen (PAS), administered on admission was able to contribute to this. METHODS Patients referred to the MTC clinical psychology service completed the PAS during their inpatient stay over an eight-month period. Following discharge from hospital, patients were telephoned (1 month, 3 months and 6 months post injury) by a member of the clinical psychology team and asked two validated questionnaires; the Impact of Events Scale revised (IES-R) (measure of posttraumatic stress symptoms) and the CORE-10 (measure of global psychological distress). In addition, patients' data from the local Trauma Audit & Research Network (TARN) database was reviewed to identify information related to injury and other demographic data. Patients were divided into groups for comparison based upon their PAS scores using previously described severity cut offs for posttraumatic stress symptoms and depression. Receiver Operator Characteristic and Multiple Linear Regression analysis was used to examine for significant baseline predictors of psychological distress during follow up according to the IES and CORE-10 scores. RESULTS One hundred and fourteen patients completed the PAS over the study period. Follow-up psychological data was available for 63 (56%) of patients. Except for the patient's home address, no baseline parameter examined in this study regarding patient demographics, injury or treatment was associated with reported psychological symptoms in the first six months post injury as measured by the IES-R or CORE-10 scores. Multiple linear regression analysis revealed that both PAS-P and PAS-D were significant predictor variables for patients reporting significant symptoms of posttraumatic stress and global psychological distress (according to IES-R and CORE-10 scores) in the first six months post injury. CONCLUSIONS Psychological screening on admission may be helpful in identifying patients admitted to MTCs who are at risk at developing posttraumatic stress symptoms and psychological distress following major trauma.
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Affiliation(s)
- L Johnson
- The Leeds Major Trauma Centre, Leeds General Infirmary, Leeds, LS1 3EX, United Kingdom.
| | - C Lodge
- The Leeds Major Trauma Centre, Leeds General Infirmary, Leeds, LS1 3EX, United Kingdom
| | - S Vollans
- The Leeds Major Trauma Centre, Leeds General Infirmary, Leeds, LS1 3EX, United Kingdom
| | - P J Harwood
- The Leeds Major Trauma Centre, Leeds General Infirmary, Leeds, LS1 3EX, United Kingdom
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Hosseininejad SM, Jahanian F, Elyasi F, Mokhtari H, Koulaei ME, Pashaei SM. The prevalence of post-traumatic stress disorder among emergency nurses: a cross sectional study in northern Iran. Biomedicine (Taipei) 2019; 9:19. [PMID: 31453800 PMCID: PMC6711322 DOI: 10.1051/bmdcn/2019090319] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 05/26/2019] [Indexed: 12/27/2022] Open
Abstract
Background and objective: Posttraumatic stress disorder (PTSD) is one of the anxiety disorders which occurs in response to facing events and accidents accompanied by fear, frustration, and terror. Nurses who worked in the emergency departments witness unpleasant accidents and are exposed to stress and violence more than others. The aim of this study was to investigate the prevalence of PTSD among Iranian nurses working in the emergency department. Materials and Methods: In this cross-sectional study, all nurses working in the emergency department of educational hospitals affiliated with Mazandaran University of Medical Sciences were included through census method (n = 131). Each of the participants in this study responded to the questionnaires individually. The first part of the questionnaire captured demographics, while the second part was the Civilian Mississippi Scale for PTSD, which was used to investigate the extent of PTSD in this study. Data were analyzed using SPSS version 22. Results: In this study, 131 respondents were included. In the classification of age, nurses with 20-30-year- old had the maximum frequency (41.2 %,). Most nurses in the study (93.1%, n = 122) had a bachelor’s degree in nursing and 84 were married. The prevalence of PTSD in emergency nurses was 82.96%, which was higher in nurses with shorter working background and nurses with lower levels of education. Further, the average score of PTSD was higher in married nurses. Conclusion: The results of this study revealed the high prevalence of PTSD among nurses who worked in emergency department. Therefore, it seems that designing and providing supportive and educational services to emergency nurses can be effective for preventing and managing this disorder, which probably can improve their performance.
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Affiliation(s)
- Seyed Mohammad Hosseininejad
- Department of Emergency Medicine, Diabetes Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fatemeh Jahanian
- Department of Emergency Medicine, Gut and Liver Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Forouzan Elyasi
- Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Faculty of Medicine, Mazandaran University of Medical Science, Sari, Iran
| | - Hossein Mokhtari
- Head Nurse of Emergency Department, Sari Imam Khomeini Hospital, Mazandaran University of Medical Science, Sari, Iran
| | - Mohammad Eslami Koulaei
- Department of Emergency Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyedeh Masoumeh Pashaei
- Department of Emergency Medicine, Orthopedic Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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Ranney M, Karb R, Ehrlich P, Bromwich K, Cunningham R, Beidas RS. What are the long-term consequences of youth exposure to firearm injury, and how do we prevent them? A scoping review. J Behav Med 2019; 42:724-740. [PMID: 31367937 PMCID: PMC8321509 DOI: 10.1007/s10865-019-00035-2] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/23/2019] [Indexed: 12/14/2022]
Abstract
The long-term consequences of exposure to firearm injury-including suicide, assault, and mass shootings-on children's mental and physical health is unknown. Using PRISMA-ScR guidelines, we conducted a scoping review of four databases (PubMed, Scopus, PsychINFO, and CJ abstract) between January 1, 1985 and April 2, 2018 for articles describing long-term outcomes of child or adolescent firearm injury exposure (n = 3582). Among included studies (n = 31), most used retrospective cohorts or cross-sectional studies to describe the correlation between firearm injury and post-traumatic stress. A disproportionate number of studies examined the effect of mass shootings, although few of these studies were conducted in the United States and none described the impact of social media. Despite methodologic limitations, youth firearm injury exposure is clearly linked to high rates of post-traumatic stress symptoms and high rates of future injury. Evidence is lacking on best practices for prevention of mental health and behavioral sequelae among youth exposed to firearm injury. Future research should use rigorous methods to identify prevalence, correlates, and intervention strategies for these at-risk youth.
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Affiliation(s)
- Megan Ranney
- Department of Emergency Medicine, Alpert Medical School, Brown University, 593 Eddy Street, Claverick 2, Providence, RI, 02903, USA.
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, 121 South Main Street, Providence, RI, 02903, USA.
- American Foundation for Firearm Injury Reduction in Medicine, PO Box 503, Williamstown, MA, 01267, USA.
| | - Rebecca Karb
- Department of Emergency Medicine, Alpert Medical School, Brown University, 593 Eddy Street, Claverick 2, Providence, RI, 02903, USA
| | - Peter Ehrlich
- Department of Surgery, Section of Pediatric Surgery, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Kira Bromwich
- Department of Emergency Medicine, Alpert Medical School, Brown University, 593 Eddy Street, Claverick 2, Providence, RI, 02903, USA
| | - Rebecca Cunningham
- Department of Emergency Medicine, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Rinad S Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3015, Philadelphia, PA, 19104, USA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk #210, Philadelphia, PA, 19104, USA
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Driver S, Juengst S, McShan EE, Bennett M, Bell K, Dubiel R. A randomized controlled trial protocol for people with traumatic brain injury enrolled in a healthy lifestyle program (GLB-TBI). Contemp Clin Trials Commun 2019; 14:100328. [PMID: 30775611 PMCID: PMC6365803 DOI: 10.1016/j.conctc.2019.100328] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/10/2019] [Accepted: 01/18/2019] [Indexed: 01/07/2023] Open
Abstract
Weight gain is prevalent among people with traumatic brain injury (TBI) and may be attributable to environmental or injury-specific factors such as mobility impairment, endocrine dysfunction, behavioral and emotional disorders, and sensory loss. Few weight management programs exist to meet the unique needs of this population. Researchers modified a nationally recognized, evidence-based weight-loss program, Group Lifestyle Balance™ (GLB), to address the needs of over-weight and obese people post TBI (GLB-TBI). This current randomized controlled trial (RCT) examines the efficacy of the GLB-TBI on weight and secondary outcomes compared to an attention control educational support group. Furthermore, researchers have developed a mobile technology app to further engage participants in the program. This RCT will enroll and randomize 66 participants over a two-year period. It is anticipated that findings from this current RCT will contribute to the knowledge and evidence for an effective weight-loss intervention among this underserved population, with a goal of achieving full recognition by the Centers for Disease Control and Prevention-National Diabetes Prevention Program and subsequent Center for Medicare and Medicaid Services reimbursement for participation.
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Affiliation(s)
- Simon Driver
- North Texas Traumatic Brain Injury Model System, USA
- Baylor Scott and White Institute for Rehabilitation, 909 N. Washington, Dallas, TX, 75246, USA
| | - Shannon Juengst
- North Texas Traumatic Brain Injury Model System, USA
- University of Texas at Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Evan Elizabeth McShan
- North Texas Traumatic Brain Injury Model System, USA
- Baylor Scott and White Institute for Rehabilitation, 909 N. Washington, Dallas, TX, 75246, USA
| | - Monica Bennett
- North Texas Traumatic Brain Injury Model System, USA
- Baylor Scott and White Health, 8080 N. Central Expy, Dallas, TX, 75206, USA
| | - Kathleen Bell
- North Texas Traumatic Brain Injury Model System, USA
- University of Texas at Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Rosemary Dubiel
- North Texas Traumatic Brain Injury Model System, USA
- Baylor Scott and White Institute for Rehabilitation, 909 N. Washington, Dallas, TX, 75246, USA
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Hung YW, Musci R, Tol W, Aketch S, Bachani AM. Longitudinal depressive and anxiety symptoms of adult injury patients in Kenya and their risk factors. Disabil Rehabil 2019; 42:3816-3824. [PMID: 31081392 DOI: 10.1080/09638288.2019.1610804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Injuries account for a significant proportion of the health and economic burden for populations in low- and middle-income countries. However, little is known about psychological distress trajectories amongst injury survivors in low- and middle-income countries.Methods: Adult injury patients (n = 644) admitted to Kenyatta National Hospital in Nairobi, Kenya, were enrolled and interviewed in the hospital, and at 1, 2-3, and 4-7 months after hospital discharge through phone to assess depressive and anxiety symptoms and level of disability. Growth mixture modeling was applied to identify latent trajectories of depressive and anxiety symptoms.Results: Elevated depressive and moderate-level anxiety symptoms (13%) and low depressive and anxiety symptoms (87%) trajectories were found between hospitalization and up to seven months after hospital discharge. Being female, prior trauma experience, longer hospitalization, worse self-rated health status while in the hospital, and lack of monetary assistance during hospitalization were associated with the elevated symptoms trajectory. The higher symptoms trajectory associated with higher disability levels after hospital discharge and significantly lower proportion of resuming daily activities and work.Conclusion: The persistence of elevated depressive symptoms and associated reduced functioning several months after physical injury underscores the importance of identifying populations at risk for preventive and early interventions.Implications for RehabilitationHealth providers following up with injury survivors should screen for depressive and anxiety symptomsSpecial attention to women and people with a potential traumatic exposure historyIncorporation of evidence-based culturally adapted psychosocial interventions in rehabilitation and outpatient clinics.
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Affiliation(s)
- Yuen W Hung
- Department of Health Sciences, Wilfred Laurier University, Waterloo, Canada
| | - Rashelle Musci
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Wietse Tol
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Abdulgafoor M Bachani
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Wilson N, Heke S, Holmes S, Dain V, Priebe S, Bridle C, Aylen I, Boyd C, Ramjaun G, Kanzaria A. Prevalence and predictive factors of psychological morbidity following facial injury: a prospective study of patients attending a maxillofacial outpatient clinic within a major UK city. DIALOGUES IN CLINICAL NEUROSCIENCE 2019. [PMID: 30936771 PMCID: PMC6436951 DOI: 10.31887/dcns.2018.20.4/sheke] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Adults presenting to maxillofacial surgery services are at high risk of psychological morbidity. This study examined the prevalence of depression, post-traumatic stress disorder (PTSD), anxiety, drug and alcohol use, and appearance-related distress among maxillofacial trauma outpatients over medium-term follow-up. It also explored socio-demographic and injury-related variables associated with psychological distress to inform targeted psychological screening protocols for maxillofacial trauma services. Significant associations were found between level of distress at time of injury and number of traumatic life events with levels of depression at 3 months. No significant associations were found between predictor variables and PTSD at 3 months, or with any psychiatric diagnosis at 6 months. The lack of evidence for an identifiable subgroup of patients who were at higher risk of psychological distress indicated that routine screening of all maxillofacial trauma outpatients should be offered in order to best respond to their mental health needs. The feasibility of the medical team facilitating this is challenging and should ideally be undertaken by psychologists integrated within the MDT. This study led to the funding of a clinical psychologist to provide collaborative care with the maxillofacial surgeons, resulting in brief assessment and treatment to over 600 patients in the first year of the service.
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Affiliation(s)
- Naomi Wilson
- Institute of Psychotrauma, East London NHS Foundation Trust, London, UK
| | - Sarah Heke
- Institute of Psychotrauma, East London NHS Foundation Trust, London, UK
| | - Simon Holmes
- Oral and Maxillofacial Surgery Department, the Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Victoria Dain
- Institute of Psychotrauma, East London NHS Foundation Trust, London, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, UK
| | - Christopher Bridle
- Oral and Maxillofacial Surgery Department, the Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Imogen Aylen
- Department of Psychology, University of East London, London, UK
| | - Caroline Boyd
- Department of Psychology, University of East London, London, UK
| | - Gonca Ramjaun
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, UK
| | - Amar Kanzaria
- Oral and Maxillofacial Surgery Department, the Royal London Hospital, Barts Health NHS Trust, London, UK
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Do screening and a randomized brief intervention at a Level 1 trauma center impact acute stress reactions to prevent later development of posttraumatic stress disorder? J Trauma Acute Care Surg 2019; 85:466-475. [PMID: 29787532 DOI: 10.1097/ta.0000000000001977] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Approximately 20% to 40% of trauma survivors experience posttraumatic stress disorder (PTSD). The American College of Surgeons Committee on Trauma reports that early screening and referral has the potential to improve outcomes and that further study of screening and intervention for PTSD would be beneficial. This prospective randomized study screened hospitalized patients for traumatic stress reactions and assessed the effect of a brief intervention in reducing later development of PTSD. METHODS The Primary Care PTSD (PC-PTSD) screen was administered to admitted patients. Patients with symptoms were randomized to an intervention or control group. The brief intervention focused on symptom education and normalization, coping strategies, and utilizing supports. The control group received a 3-minute educational brochure review. Both groups completed in-hospital interviews, then 45- and 90-day telephone interviews. Follow-up collected the PTSD checklist-civilian (PCL-C) assessment and qualitative data on treatment-seeking barriers. RESULTS The PC-PTSD screen was successful in predicting later PTSD symptoms at both 45 days (β = 0.43, p < 0.001) and 90 days (β = 0.37, p < 0.001) even after accounting for depression. Correlations of the intervention with the PCL-C scores and factor score estimates did not reach statistical significance at either time point (p = 0.827; p = 0.838), indicating that the brief intervention did not decrease PTSD symptoms over time. Of those at or above the PCL-C cutoff at follow-ups, a minority had sought treatment for their symptoms (43.2%). Primary barriers included focusing on their injury or ongoing rehabilitation, financial concerns, or location of residence. CONCLUSION The PC-PTSD screen identified patients who later assess positive for PTSD using the PCL-C. The brief intervention did not reduce 45- and 90-day PTSD development. Follow-up interviews revealed lack of treatment infrastructure in the community. It will be important for trauma centers to align with community resources to address the treatment needs of at-risk patients. LEVEL OF EVIDENCE Prospective randomized controlled trial, level II.
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Culp BL, Roden-Foreman JW, Thomas EV, McShan EE, Bennett MM, Martin KR, Powers MB, Foreman ML, Petrey LB, Warren AM. Better with age? A comparison of geriatric and non-geriatric trauma patients' psychological outcomes 6 months post-injury. Cogn Behav Ther 2018; 48:406-418. [PMID: 30392449 DOI: 10.1080/16506073.2018.1533578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This is the first study to compare both physical and psychological outcomes in geriatric and non-geriatric patients (n = 268) at baseline and 6 months post-trauma. Demographic, clinical, and psychological data, including screens for alcohol use, depressive symptoms, and post-traumatic stress symptoms (PTSS) were collected from 67 geriatric patients (70.7 ± 8.0 years) and 201 non-geriatric patients (40.2 ± 12.8 years) admitted to a Level I trauma center for ≥ 24 h. Geriatric patients were significantly less likely to screen positive for alcohol use at baseline, and depression, PTSS, and alcohol use at follow-up. When not controlling for discharge to rehabilitation or nursing facility, geriatric patients had significantly lower odds of alcohol use at follow-up. There was no significant difference in injury severity, resilience, or pre-trauma psychological status between the two groups. Results indicate that geriatric trauma patients fare better than their younger counterparts at 6 months post-trauma on measures of alcohol use, depression, and PTSS. Screenings and interventions for both age groups could improve psychological health post-trauma, but younger patients may require additional attention.
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Affiliation(s)
- Brittney L Culp
- a Department of Surgery, Baylor Scott & White - Grapevine , Grapevine , TX , USA
| | - Jacob W Roden-Foreman
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Estrella V Thomas
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Evan Elizabeth McShan
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Monica M Bennett
- c Baylor Scott & White Health, Center for Clinical Effectiveness , Dallas , TX , USA
| | - Katherine Riley Martin
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Mark B Powers
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Michael L Foreman
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Laura B Petrey
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Ann Marie Warren
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
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Richmond TS, Foman M. Firearm Violence: A Global Priority for Nursing Science. J Nurs Scholarsh 2018; 51:229-240. [PMID: 30215887 DOI: 10.1111/jnu.12421] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE This purpose of this article is to frame firearm violence as a health and public health problem, to illustrate the magnitude of the problem, to examine factors that increase the risk to be injured by a firearm, or conversely, that confer protection, and to identify relevant priority areas for nursing science. ORGANIZING CONSTRUCT Firearm violence results in physical and psychological injuries and is a global health priority. Firearm violence is categorized as intentional (interpersonal and self-inflicted) and unintentional (interpersonal and self-inflicted) and accounts for an estimated 196,000 to 220,000 nonconflict deaths annually. METHODS We reviewed the theoretical and scientific literature to analyze the magnitude and geographic distribution of firearm violence, the factors associated with firearm injury, the consequences of firearm violence, and areas where nursing science can make an impact on prevention, outcomes, and recovery. FINDINGS Firearm violence is a significant public health problem that affects the health of individuals, families, and communities. The burdens and contributors to firearm violence vary worldwide, making it important to understand the local context of this global phenomenon. Relevant areas of inquiry span primary prevention focusing on individual and environmental risk factors; and focus on managing the physical and psychological consequences postinjury; and mitigating long-term consequences of firearm violence. CONCLUSIONS Reducing the global burden of firearm violence and improving the health and safety of individuals, families, and communities provide compelling reasons to integrate this area into nursing science. CLINICAL RELEVANCE The goals of nursing are to keep people healthy and safe and to help return those injured to their optimal levels of health and well-being. Understanding the factors that come together to injure people with a firearm in various physical, social, economic, and cultural environments positions nurses to both extend the dialogue beyond pro-gun versus anti-gun and to design and carry out rigorous studies to reduce firearm violence.
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Affiliation(s)
- Therese S Richmond
- Andrea B. Laporte Professor of Nursing, Associate Dean for Research & Innovation, Biobehavioral Health Sciences Department, School of Nursing, University of Pennsylvania, Penn Injury Science Center, Philadelphia, PA, USA
| | - Matthew Foman
- Research Assistant, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.,Student, History and Sociology of Science Department, School of Arts & Sciences, University of Pennsylvania, Philadelphia, PA, USA
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Weimert S, Kuhn S, Rommens PM, Beutel ME, Reiner I. Psychische Faktoren bei Sprunggelenkfrakturen. Unfallchirurg 2018; 122:464-468. [DOI: 10.1007/s00113-018-0550-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kendrick D, Baker R, Hill T, Beckett K, Coupland C, Kellezi B, Joseph S, Barnes J, Sleney J, Christie N, Morriss R. Early risk factors for depression, anxiety and post-traumatic distress after hospital admission for unintentional injury: Multicentre cohort study. J Psychosom Res 2018; 112:15-24. [PMID: 30097131 DOI: 10.1016/j.jpsychores.2018.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 06/11/2018] [Accepted: 06/11/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To quantify psychological morbidity and identify baseline factors associated with depression, anxiety and post-traumatic distress symptoms up to 12 months post-injury. METHODS Multicentre cohort study of 668 adults, aged 16 to 70, admitted to 4 UK NHS hospital trusts. Data on injury, socio-demographic characteristics and health status was collected at recruitment. Depression, anxiety and post-traumatic distress were measured at 1, 2, 4 and 12 months post-injury. Multilevel linear regression assessed associations between patient and injury characteristics and psychological outcomes over 12 months follow-up. RESULTS Depression, anxiety and post-traumatic distress scores were highest 1 month post-injury, and remained above baseline at 2, 4 and 12 months post-injury. Moderate or severe injuries, previous psychiatric diagnoses, higher pre-injury depression and anxiety scores, middle age (45-64 years), greater deprivation and lower pre-injury quality of life (QoL) were associated with higher depression scores post-injury. Previous psychiatric diagnoses, higher pre-injury depression and anxiety scores, middle age, greater deprivation and lower pre-injury QoL were associated with higher anxiety scores post-injury. Traffic injuries or injuries from being struck by objects, multiple injures (≥3), being female, previous psychiatric diagnoses, higher pre-injury anxiety scores and greater deprivation were associated with higher post-traumatic distress scores post-injury. CONCLUSION A range of risk factors, identifiable shortly after injury, are associated with psychological morbidity occurring up to 12 months post-injury in a general trauma population. Further research is required to explore the utility of these, and other risk factors in predicting psychological morbidity on an individual patient basis.
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Affiliation(s)
- D Kendrick
- Division of Primary Care, School of Medicine, University of Nottingham, NG7 2RD, UK.
| | - R Baker
- Division of Primary Care, School of Medicine, University of Nottingham, NG7 2RD, UK
| | - T Hill
- Division of Primary Care, School of Medicine, University of Nottingham, NG7 2RD, UK
| | - K Beckett
- Centre for Health & Clinical Research, University of the West of England, BS16 1DD, UK
| | - C Coupland
- Division of Primary Care, School of Medicine, University of Nottingham, NG7 2RD, UK
| | - B Kellezi
- Department of Psychology, Nottingham Trent University, NG1 4BU, UK
| | - S Joseph
- School of Education, University of Nottingham, NG8 1BB, UK
| | - J Barnes
- Loughborough Design School, Loughborough University, LE11 3TU, UK
| | - J Sleney
- Department of Sociology, University of Surrey, GU2 7XH, UK
| | - N Christie
- Centre for Transport Studies, University College London, WC1E 6BT, UK
| | - R Morriss
- Division of Psychiatry and Applied Psychology, University of Nottingham, NG7 2TU, UK
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Herrera-Escobar JP, Al Rafai SS, Seshadri AJ, Weed C, Apoj M, Harlow A, Brasel K, Kasotakis G, Kaafarani HMA, Velmahos G, Salim A, Haider AH, Nehra D. A multicenter study of post-traumatic stress disorder after injury: Mechanism matters more than injury severity. Surgery 2018; 164:1246-1250. [PMID: 30170820 DOI: 10.1016/j.surg.2018.07.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 07/03/2018] [Accepted: 07/18/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Traumatic injury is strongly associated with long-term mental health disorders, but the risk factors for developing these disorders are poorly understood. We report on a multi-institutional collaboration to collect long-term patient-centered outcomes after trauma, including screening for post-traumatic stress disorder. The objective of this study is to determine the prevalence of and risk factors for the development of post-traumatic stress disorder after traumatic injury. METHODS Adult trauma patients (aged 18-64) with moderate to severe injuries (Injury Severity Score ≥ 9) admitted to 3 level I trauma centers were screened between 6 and 12 months after injury for post-traumatic stress disorder. Patients were divided by mechanism: fall, road traffic injury, and intentional injury. Multiple logistic regression models were used to determine the association between baseline patient and injury-related characteristics and the development of post-traumatic stress disorder for the overall cohort and by mechanism of injury. RESULTS A total of 450 patients completed the screen. Overall 32% screened positive for post-traumatic stress disorder, but this differed significantly by mechanism, with the lowest being after a fall (25%) and highest after intentional injury (60%). Injury severity was not associated with post-traumatic stress disorder for any group, but lower educational level was associated with post-traumatic stress disorder within all the groups. Only 21% of patients who screened positive for post-traumatic stress disorder were receiving treatment at the time of the survey. CONCLUSION Post-traumatic stress disorder is common after traumatic injury, and the prevalence varies significantly by injury mechanism but is not associated with injury severity. Only a small proportion of patients who screen positive for post-traumatic stress disorder are currently receiving treatment.
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Affiliation(s)
- Juan P Herrera-Escobar
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard T. H Chan School of Public Health, Boston, MA
| | - Syeda S Al Rafai
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard T. H Chan School of Public Health, Boston, MA
| | - Anupamaa J Seshadri
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard T. H Chan School of Public Health, Boston, MA
| | - Christina Weed
- Department of Surgery, Virginia Mason Medical Center, Seattle, WA
| | - Michel Apoj
- Department of Surgery, Division of Trauma, Acute Care Surgery & Surgical Critical Care, Boston University School of Medicine, Boston, MA
| | - Alyssa Harlow
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard T. H Chan School of Public Health, Boston, MA
| | - Karen Brasel
- Department of Surgery, Division of Trauma, Critical Care & Acute Care Surgery, Oregon Health and Science University, Portland, OR
| | - George Kasotakis
- Department of Surgery, Division of Trauma, Acute Care Surgery & Surgical Critical Care, Boston University School of Medicine, Boston, MA
| | - Haytham M A Kaafarani
- Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - George Velmahos
- Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ali Salim
- Department of Surgery, Division of Trauma, Burn and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Adil H Haider
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard T. H Chan School of Public Health, Boston, MA; Department of Surgery, Division of Trauma, Burn and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Deepika Nehra
- Department of Surgery, Division of Trauma, Burn and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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Hawn SE, Lind MJ, Conley A, Overstreet CM, Kendler KS, Dick DM, Amstadter AB. Effects of social support on the association between precollege sexual assault and college-onset victimization. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2018; 66:467-475. [PMID: 29405876 PMCID: PMC6078834 DOI: 10.1080/07448481.2018.1431911] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 09/06/2017] [Accepted: 10/31/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This study examined the moderating and mediating effects of perceived social support on the association between precollege sexual assault (SA) and college-onset SA. PARTICIPANTS A representative sample of 6,132 undergraduates. METHODS The PLUM procedure in SPSS was used to test the moderation model, with individual regressions conducted in a hierarchical fashion. A weighted least squared mean and variance adjusted (WLSMV) mediation model was used to examine the mediating effect of social support. RESULTS Precollege SA significantly predicted college-onset SA. Social support significantly mediated the relation between precollege SA and college-onset SA. Social support was not a significant moderator of this relationship. CONCLUSIONS Given the high prevalence of SA among college populations, as well as the high rates of SA revictimization, identification of factors that may be related to repeated SA (eg, low social support) within this population are essential and may inform intervention, policy, and university student services.
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Affiliation(s)
- Sage E Hawn
- a Department of Psychiatry , Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University , Richmond , Virginia , USA
- b Department of Psychology , Virginia Commonwealth University , Richmond , Virginia , USA
| | - Mackenzie J Lind
- a Department of Psychiatry , Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University , Richmond , Virginia , USA
| | - Abigail Conley
- c Department of Counseling and Special Education , Virginia Commonwealth University , Richmond , Virginia , USA
| | - Cassie M Overstreet
- a Department of Psychiatry , Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University , Richmond , Virginia , USA
- b Department of Psychology , Virginia Commonwealth University , Richmond , Virginia , USA
| | - Kenneth S Kendler
- a Department of Psychiatry , Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University , Richmond , Virginia , USA
- d Department of Human and Molecular Genetics , Virginia Commonwealth University , Richmond , Virginia , USA
| | - Danielle M Dick
- b Department of Psychology , Virginia Commonwealth University , Richmond , Virginia , USA
- d Department of Human and Molecular Genetics , Virginia Commonwealth University , Richmond , Virginia , USA
| | - Ananda B Amstadter
- a Department of Psychiatry , Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University , Richmond , Virginia , USA
- b Department of Psychology , Virginia Commonwealth University , Richmond , Virginia , USA
- d Department of Human and Molecular Genetics , Virginia Commonwealth University , Richmond , Virginia , USA
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Early psychological interventions for posttraumatic stress, depression and anxiety after traumatic injury: A systematic review and meta-analysis. Clin Psychol Rev 2018; 62:11-36. [DOI: 10.1016/j.cpr.2018.05.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 02/27/2018] [Accepted: 05/03/2018] [Indexed: 12/22/2022]
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Lasting impression of violence: Retained bullets and depressive symptoms. Injury 2018; 49:135-140. [PMID: 28882377 PMCID: PMC5771869 DOI: 10.1016/j.injury.2017.08.057] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 08/17/2017] [Accepted: 08/23/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Over 70,000 nonfatal firearm injuries occur in the US annually, frequently leaving victims injured with retained bullets. The long-term psychological risks associated with retained bullets remains unstudied. By serving as a constant reminder of injury, we hypothesized that the presence of retained bullets after firearm injury is associated with increased PTSD and depression symptom severity. METHODS We conducted a prospective cohort study (2013-2015) of Black male survivors of firearm injury at an urban Level I trauma center. Interviews, questionnaires and validated survey tools for PTSD (PCL-5) and depression (QIDS-SR16) to assess severity of symptoms were administered 3 months post-injury. Clinical characteristics and symptom severity scores were compared with respect to retained bullets using Wilcoxon Rank Sum tests and linear regression. RESULTS Of 139 participants, 101(73%) had retained bullets. The cohort was young (mean age 26 years), educated (82% high school or greater) yet unemployed (53%) and with multiple injuries (median [IQR] no. of GSWs 2 [1-3]). There was no difference in age, education, employment status, number of gunshot wounds, operative procedures, pain, hospital or ICU LOS between groups (p>0.05). Patients with retained bullets less often rated their health as "very good" or "excellent" (10% vs 29%, p=0.046). Of those working prior to injury (n=47), 61% with retained bullets had not returned to work compared to 33% without retained bullets (p=0.027). No difference in PCL-5 scores [30.9 (SD 18.9) vs 27.9 (SD 18.6), p=0.470] was observed, but patients with retained bullets had greater mean QIDS-SR16 scores [10.7 (SD 6.2) vs 7.8 (SD 6.1), p=0.038] than those without. After controlling for injury severity, number of wounds, marital status and education level, multiple linear regression analysis determined that retained bullets (β=3.52; p=0.017) were associated with more severe depressive symptoms. CONCLUSION Retained bullets are associated with adverse psychological consequences after firearm injury. To improve recovery and to aid in clinical management decisions, clinicians should consider both the psychological and physical effects of retained bullets in survivors of firearm injury.
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khodadadi-hassankiadeh N, Dehghan-Nayeri N, Shahsavari H, Yousefzadeh-Chabok S, Haghani H. Psycho-social and Mental Variables and Post-Traumatic Stress Disorder in Traffic Accident Survivors in Northern Iran. Bull Emerg Trauma 2017; 5:197-205. [PMID: 28795065 PMCID: PMC5547208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 03/08/2017] [Accepted: 04/07/2017] [Indexed: 06/07/2023] Open
Abstract
OBJECTIVE To assess the psycho-social and mental variables associated with post-traumatic stress disorder (PTSD) in a series of Iranian patients. METHODS A total of 528 eligible accident survivors in pre-sampling of a randomized controlled trial targeting PTSD were included in this cross-sectional study. Psycho-social characteristics associated to PTSD were explored in these survivors in an outpatient clinic. They completed the questionnaires via interview between six weeks to six months after accident. Data collection tools were PSS (DSM-V version) for PTSD and BDI-II for depression and a researcher-made questionnaire for psycho-social variables. RESULTS There was a significant association between PTSD and the following variables; family communication, current depression, return to work, history of death of relatives, witnessed the death, length of amnesia, hospitalization, injured situation, and accident severity. Multivariate logistic regression indicated that some variables were associated with PTSD such as accident severity, (p<0.001), injured situation, (p<0.001), current depression, (p<0.001), RTW (p<0.001), and family communication (p=0.01). CONCLUSION Psychiatric nursing prevention efforts is best directed toward motorcycle depressed drivers with severe accident and poor family communication who do not return to work. Thus, routine assessment of PTSD, depression and psycho-social variables after traffic accidents must be taken into account.
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Affiliation(s)
| | - Nahid Dehghan-Nayeri
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Hooman Shahsavari
- School of Nursing and Midwifery. Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrokh Yousefzadeh-Chabok
- Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Guilan, Iran.
- Neuroscience Research Center, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Hamid Haghani
- Department of Biostatistics, School of Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
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Kim JW, Kang HJ, Bae KY, Kim SW, Oh HK, Kim MG, Kim JM. Development of a Biomarker-Based Diagnostic Algorithm for Posttraumatic Syndrome after Physical Injury: Design of the BioPTS Study. Psychiatry Investig 2017; 14:513-517. [PMID: 28845180 PMCID: PMC5561411 DOI: 10.4306/pi.2017.14.4.513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/11/2016] [Accepted: 06/23/2016] [Indexed: 12/17/2022] Open
Abstract
Severe physical injury is a leading cause of posttraumatic syndrome (PTS). This is to develop a biomarker-based diagnostic algorithm for posttraumatic syndrome (BioPTS) study. This is a 2-year longitudinal cohort study assessing patients who were hospitalized beginning in 2015 at Chonnam National University Hospital in Gwangju, Korea, after experiencing severe physical injuries. Baseline evaluations were made during the acute phase (within 1 month) of the physical injury and included extensive information on sociodemographic and clinical variables as well as a list of biomarkers. All participants will be followed up for 2 years, and the diagnostic and predictive validities of various biomarkers for PTS will be estimated. The BioPTS study will develop the most accurate models for the diagnosis and prediction of PTS, and will contribute to existing research regarding the complex relationships between severe physical injury and psychological issues.
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Affiliation(s)
- Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Advanced Photonics Research Institute, Gwangju Institute of Science & Technology (GIST), Gwangju, Republic of Korea
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Advanced Photonics Research Institute, Gwangju Institute of Science & Technology (GIST), Gwangju, Republic of Korea
| | - Kyung-Yeol Bae
- Department of Psychiatry, Chonnam National University Medical School, Advanced Photonics Research Institute, Gwangju Institute of Science & Technology (GIST), Gwangju, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Advanced Photonics Research Institute, Gwangju Institute of Science & Technology (GIST), Gwangju, Republic of Korea
| | - Hyun-Kyong Oh
- Department of Psychiatry, Chonnam National University Medical School, Advanced Photonics Research Institute, Gwangju Institute of Science & Technology (GIST), Gwangju, Republic of Korea
| | - Min-Gon Kim
- Department of Psychiatry, Chonnam National University Medical School, Advanced Photonics Research Institute, Gwangju Institute of Science & Technology (GIST), Gwangju, Republic of Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Advanced Photonics Research Institute, Gwangju Institute of Science & Technology (GIST), Gwangju, Republic of Korea
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47
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The course, prediction, and treatment of acute and posttraumatic stress in trauma patients. J Trauma Acute Care Surg 2017; 82:1158-1183. [DOI: 10.1097/ta.0000000000001447] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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48
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Zatzick DF, Rowhani-Rahbar A, Wang J, Russo J, Darnell D, Ingraham L, Whiteside LK, Guiney R, Hedrick MK, Rivara FP. The Cumulative Burden of Mental, Substance Use, and General Medical Disorders and Rehospitalization and Mortality After an Injury. Psychiatr Serv 2017; 68:596-602. [PMID: 28142384 PMCID: PMC5550030 DOI: 10.1176/appi.ps.201600311] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Each year in the United States, 1.5-2.5 million individuals require hospitalization for an injury. Multiple mental, substance use, and chronic general medical disorders are endemic among injury survivors with and without traumatic brain injury (TBI), yet few studies have assessed the association between the cumulative burden of these conditions and health care outcomes. This study of patients hospitalized for an injury assessed associations between comorbid mental, substance use, and general medical disorders, TBI, and violent events or suicide attempts and the postinjury outcomes of recurrent hospitalization and death. METHODS Recurrent hospitalization and all-cause mortality were examined in this population-based retrospective cohort study. A total of 76,942 patients hospitalized for an injury in Washington State during 2006-2007 were followed for five years. ICD-9-CM codes identified conditions prior to or at the index injury admission. Index admissions related to injuries from firearms, assaultive violence, suicide attempts, and overdoses were identified through E-codes. RESULTS Adjusted regression analyses demonstrated a significant, dose-response relationship between an increasing cumulative burden of disorders and an increasing risk of recurrent hospitalization (four or more conditions, relative risk=3.89, 95% confidence interval [CI]=3.66-4.14). Adjusted Cox proportional hazard regression demonstrated a similar relationship between increasing cumulative burden of disorders and all-cause mortality (four or more conditions, hazard ratio=5.33, CI=4.71-6.04). CONCLUSIONS Increasing cumulative burden of disorders was associated with greater postinjury risk of recurrent hospitalization and death. Orchestrated investigative and policy efforts could introduce screening and intervention procedures that target this spectrum of comorbidity.
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Affiliation(s)
- Douglas F Zatzick
- Dr. Zatzick, Dr. Russo, Dr. Darnell, Ms. Ingraham, Ms. Guiney, and Ms. Hedrick are with the Department of Psychiatry and Behavioral Sciences, Dr. Rowhani-Rahbar is with the Department of Epidemiology, Dr. Whiteside is with the Department of Emergency Medicine, and Dr. Rivara is with the Department of Pediatrics, all at the University of Washington School of Medicine, Seattle (e-mail: ). Dr. Zatzick, Dr. Rowhani-Rahbar, Dr. Whiteside, Ms. Guiney, and Dr. Rivara are also with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, where Dr. Wang is affiliated
| | - Ali Rowhani-Rahbar
- Dr. Zatzick, Dr. Russo, Dr. Darnell, Ms. Ingraham, Ms. Guiney, and Ms. Hedrick are with the Department of Psychiatry and Behavioral Sciences, Dr. Rowhani-Rahbar is with the Department of Epidemiology, Dr. Whiteside is with the Department of Emergency Medicine, and Dr. Rivara is with the Department of Pediatrics, all at the University of Washington School of Medicine, Seattle (e-mail: ). Dr. Zatzick, Dr. Rowhani-Rahbar, Dr. Whiteside, Ms. Guiney, and Dr. Rivara are also with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, where Dr. Wang is affiliated
| | - Jin Wang
- Dr. Zatzick, Dr. Russo, Dr. Darnell, Ms. Ingraham, Ms. Guiney, and Ms. Hedrick are with the Department of Psychiatry and Behavioral Sciences, Dr. Rowhani-Rahbar is with the Department of Epidemiology, Dr. Whiteside is with the Department of Emergency Medicine, and Dr. Rivara is with the Department of Pediatrics, all at the University of Washington School of Medicine, Seattle (e-mail: ). Dr. Zatzick, Dr. Rowhani-Rahbar, Dr. Whiteside, Ms. Guiney, and Dr. Rivara are also with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, where Dr. Wang is affiliated
| | - Joan Russo
- Dr. Zatzick, Dr. Russo, Dr. Darnell, Ms. Ingraham, Ms. Guiney, and Ms. Hedrick are with the Department of Psychiatry and Behavioral Sciences, Dr. Rowhani-Rahbar is with the Department of Epidemiology, Dr. Whiteside is with the Department of Emergency Medicine, and Dr. Rivara is with the Department of Pediatrics, all at the University of Washington School of Medicine, Seattle (e-mail: ). Dr. Zatzick, Dr. Rowhani-Rahbar, Dr. Whiteside, Ms. Guiney, and Dr. Rivara are also with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, where Dr. Wang is affiliated
| | - Doyanne Darnell
- Dr. Zatzick, Dr. Russo, Dr. Darnell, Ms. Ingraham, Ms. Guiney, and Ms. Hedrick are with the Department of Psychiatry and Behavioral Sciences, Dr. Rowhani-Rahbar is with the Department of Epidemiology, Dr. Whiteside is with the Department of Emergency Medicine, and Dr. Rivara is with the Department of Pediatrics, all at the University of Washington School of Medicine, Seattle (e-mail: ). Dr. Zatzick, Dr. Rowhani-Rahbar, Dr. Whiteside, Ms. Guiney, and Dr. Rivara are also with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, where Dr. Wang is affiliated
| | - Leah Ingraham
- Dr. Zatzick, Dr. Russo, Dr. Darnell, Ms. Ingraham, Ms. Guiney, and Ms. Hedrick are with the Department of Psychiatry and Behavioral Sciences, Dr. Rowhani-Rahbar is with the Department of Epidemiology, Dr. Whiteside is with the Department of Emergency Medicine, and Dr. Rivara is with the Department of Pediatrics, all at the University of Washington School of Medicine, Seattle (e-mail: ). Dr. Zatzick, Dr. Rowhani-Rahbar, Dr. Whiteside, Ms. Guiney, and Dr. Rivara are also with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, where Dr. Wang is affiliated
| | - Lauren K Whiteside
- Dr. Zatzick, Dr. Russo, Dr. Darnell, Ms. Ingraham, Ms. Guiney, and Ms. Hedrick are with the Department of Psychiatry and Behavioral Sciences, Dr. Rowhani-Rahbar is with the Department of Epidemiology, Dr. Whiteside is with the Department of Emergency Medicine, and Dr. Rivara is with the Department of Pediatrics, all at the University of Washington School of Medicine, Seattle (e-mail: ). Dr. Zatzick, Dr. Rowhani-Rahbar, Dr. Whiteside, Ms. Guiney, and Dr. Rivara are also with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, where Dr. Wang is affiliated
| | - Roxanne Guiney
- Dr. Zatzick, Dr. Russo, Dr. Darnell, Ms. Ingraham, Ms. Guiney, and Ms. Hedrick are with the Department of Psychiatry and Behavioral Sciences, Dr. Rowhani-Rahbar is with the Department of Epidemiology, Dr. Whiteside is with the Department of Emergency Medicine, and Dr. Rivara is with the Department of Pediatrics, all at the University of Washington School of Medicine, Seattle (e-mail: ). Dr. Zatzick, Dr. Rowhani-Rahbar, Dr. Whiteside, Ms. Guiney, and Dr. Rivara are also with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, where Dr. Wang is affiliated
| | - Margot Kelly Hedrick
- Dr. Zatzick, Dr. Russo, Dr. Darnell, Ms. Ingraham, Ms. Guiney, and Ms. Hedrick are with the Department of Psychiatry and Behavioral Sciences, Dr. Rowhani-Rahbar is with the Department of Epidemiology, Dr. Whiteside is with the Department of Emergency Medicine, and Dr. Rivara is with the Department of Pediatrics, all at the University of Washington School of Medicine, Seattle (e-mail: ). Dr. Zatzick, Dr. Rowhani-Rahbar, Dr. Whiteside, Ms. Guiney, and Dr. Rivara are also with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, where Dr. Wang is affiliated
| | - Frederick P Rivara
- Dr. Zatzick, Dr. Russo, Dr. Darnell, Ms. Ingraham, Ms. Guiney, and Ms. Hedrick are with the Department of Psychiatry and Behavioral Sciences, Dr. Rowhani-Rahbar is with the Department of Epidemiology, Dr. Whiteside is with the Department of Emergency Medicine, and Dr. Rivara is with the Department of Pediatrics, all at the University of Washington School of Medicine, Seattle (e-mail: ). Dr. Zatzick, Dr. Rowhani-Rahbar, Dr. Whiteside, Ms. Guiney, and Dr. Rivara are also with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, where Dr. Wang is affiliated
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49
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The association between injustice perception and psychological outcomes in an inpatient spinal cord injury sample: the mediating effects of anger. Spinal Cord 2017; 55:898-905. [DOI: 10.1038/sc.2017.39] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 03/16/2017] [Accepted: 03/19/2017] [Indexed: 12/28/2022]
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Rahtz E, Bhui K, Smuk M, Hutchison I, Korszun A. Violent injury predicts poor psychological outcomes after traumatic injury in a hard-to-reach population: an observational cohort study. BMJ Open 2017; 7:e014712. [PMID: 28559457 PMCID: PMC5777458 DOI: 10.1136/bmjopen-2016-014712] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND People who experience physical trauma face a range of psychosocial outcomes. These may be overlooked by busy clinicians. While some risk factors are understood, understanding of the psychological effects of violent injury remains limited, particularly in UK settings. This study compared psychological outcomes following interpersonal violence and accidental injury, including the persistence of psychological distress. METHODS A questionnaire survey was carried out at two time points of patients admitted to a large teaching hospital in London between July 2012 and April 2014. Participants were consecutive adult patients admitted to the Royal London Hospital with traumatic injuries, with 219 participants at baseline. Follow-up survey was 8 months later (n=109). Standardised measures assessed post-traumatic stress symptoms (PTSS) (Acute Stress Disorder Scale and PTSD Checklist) and depressive symptoms (Hospital Anxiety and Depression Scale). RESULTS PTSS and depressive symptoms affected 27% and 33%, respectively, at baseline. At 8 months, 27% and 31% reported these symptoms for PTSS and depressive symptoms, respectively. The repeated measures were assessed with multilevel models: after adjusting for demographic factors, patients with violent injury showed more PTSS (OR 6.27, 95% CI 1.90 to 20.66) and depressive symptoms (OR 3.12, 95% CI 1.08 to 8.99). CONCLUSIONS There were high levels of psychological distress among traumatic injury patients. Violent injuries were associated with an increased risk of both post-traumatic and depressive symptoms. People vulnerable to distress would benefit from psychological support, and hospital admission provides a unique opportunity to engage hard-to-reach groups in interventions.
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Affiliation(s)
- Emmylou Rahtz
- European Centre for Environment and Human Health, University of Exeter, Truro, Cornwall, UK
| | - Kamaldeep Bhui
- Centre for Psychiatry, Barts and The London School of Medicine and Dentistry, London, UK
| | - Melanie Smuk
- Centre for Psychiatry, Barts and The London School of Medicine and Dentistry, London, UK
| | - Iain Hutchison
- Oral and Maxillofacial Surgery, St Bartholomew's and The Royal London Hospital, London, UK
| | - Ania Korszun
- Centre for Psychiatry, Barts and The London School of Medicine and Dentistry, London, UK
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